Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Thyroid disease is particularly common in women of
child-bearing age. As a result, it is no surprise that thyroid
disease may complicate the course of
pregnancy. It is
estimated that 2.5% of all pregnant women have some degree
of hypothyroidism. The frequency varies among different
populations and different countries. While pregnancy itself
is a natural state, and by no means should be considered
a "disease," thyroid disorders during pregnancy may affect
both mother and baby. This article focuses specifically on
hypothyroidism and pregnancy. After a general description
of normal and abnormal thyroid function, recent data on
long term consequences in children of mothers who had
hypothyroidism during pregnancy will be reviewed.
What is the thyroid gland?
The thyroid is a gland weighing about 15 grams (about half an ounce) that is located in the front of the neck just below the Adam's apple (cricoid cartilage). The thyroid gland is responsible for the production of the body's thyroid hormone. The thyroid responds to hormonal signals from the brain to maintain a constant level of thyroid hormone. The hormone signals are sent by specialized areas of the brain (hypothalamus and pituitary), eventually sending thyroid stimulating hormone (TSH) that promotes thyroid hormone production by the thyroid gland.
What happens with thyroid disease?
Disease of the thyroid gland is extremely common. In some
conditions, the thyroid may produce too much hormone. In
other conditions, the thyroid may be damaged or destroyed and
little, if any, thyroid hormone is produced. The main thyroid hormone
is called thyroxine, or T4.
Symptoms vary depending on whether there is too much or too little T4 in the blood. With an excess of T4 (hyperthyroidism), patients complain of feeling restless, emotionally hyper, and hot and sweaty. They may have tremors, trouble concentrating, and
weight loss. Frequent bowel movements and diarrhea are common.
If T4 levels are low (hypothyroidism) as a result of decreased production by the thyroid gland, patients often notice fatigue, lethargy, and
weight gain. Constipation is common and many patients with hypothyroidism report feeling excessively cold.
Thyroid peroxidase (TPO) is an enzyme made in the
thyroid gland that is
important in the production of thyroid hormone. TPO is found in thyroid follicle
cells where it converts the thyroid hormone T4 to"...