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.
How early does the mother's thyroid hormone affect the unborn baby?
Before birth a baby is entirely dependent on the mother for
thyroid hormone until the baby's own thyroid gland can
start to function. This usually does not occur until about
12 weeks of gestation (the end of the
first trimester of pregnancy). Thus,
hypothyroidism of the mother
may play a role early on, before many women realize they
are pregnant! In fact, the babies of mothers who were
hypothyroid in the first part of pregnancy, then adequately
treated, exhibited slower motor development than the babies
of normal mothers. However, during the later part of
pregnancy, hypothyroidism in the mother can also have
adverse effects on the baby, as pointed out by the research
described above. These children are more likely to have
intellectual impairment.
What can be done to avoid the consequences of hypothyroidism in pregnancy?
A number of medical associations and organizations have made
recommendations on screening for thyroid disease. Some of
the recommendations are listed below:
All women who are planning a pregnancy should be considered for
screening of thyroid disease.
All pregnant women with a goiter (enlarged thyroid), high blood levels
of thyroid antibodies, a family history of thyroid disease, or symptoms of
hypothyroidism should be tested for hypothyroidism.
In women who are borderline, or sub-clinical, hypothyroid (for example, not in
the laboratory range for true hypothyroidism, but within the low normal
range) and who also have positive antibodies (which may indicate an ongoing
autoimmune thyroid destruction), therapy with low dose thyroid hormone at
the onset of pregnancy may be beneficial.
There is some evidence that the antibodies that may contribute to
hypothyroidism can play a role in pregnancy. Data suggest that
selenium
supplementation may be of benefit in women with high antibody levels at the
time of preconception. This should be reviewed with your doctor.
Women who are on thyroid hormone replacement before pregnancy should
also be tested to make certain that their levels are appropriate. During
pregnancy, the medication dose required may increase by up to 50%. Increases
may be required as early as in the first trimester.
Dosing is dynamic during pregnancy and should be closely monitored by
regular blood testing. As the pregnancy progresses, many women require
higher doses of hormone replacement.
The dosage of thyroid hormone replacement during and after pregnancy
should be carefully monitored using the blood thyroid stimulating hormone
(TSH) value. The laboratory ranges for normal TSH are quite wide. Most
clinicians like to keep women who are pregnant and on replacement in the
"hyper" end of the normal range. This usually equates to a TSH of <2.0. Many
clinicians prefer TSH in the <1.0 range.
In women with hypothyroidism before conception, most go back to their
pre-pregnancy dose of thyroid hormone within a few weeks to months.
It must be stressed that these are only guidelines. The management of each woman's situation is
considered individually after consultation with her physician. The benefits of treatment extend
not only to pregnant women with hypothyroidism, but also to their children.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include: fatigue, weight gain, cold intolerance, excessive sleepiness, dry or coarse hair, difficulty swallowing, a lump in the front of the throat, and many more. Treatment is usually hypothyroid medication.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Myxedema coma is the loss of brain function due to severe longstanding low levels of thyroid hormone in the blood. Myxedema coma is a life-threatening complication of hypothyroidism. Examples of triggers of myxedema coma include medications, infections stroke, trauma and more. Some of the ymptoms of myxedema coma include: hypothermia, seizures, coma, difficulty breathing and more. Treatment of myxedema coma depend on the severity of the condition.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
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