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.
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
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.