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.
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.
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.
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.
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.