Chapter 1

It’s all about you

“Pregnant women are particularly vulnerable to iodine deficiency because early pregnancy is characterized by a rapid surge in thyroid hormone production (and iodine requirements). Late pregnancy also stresses maternal iodine stores because of increased renal clearance.”~Lockwood, 2013

“The physiologic changes associated with pregnancy require an increased availability of thyroid hormones by 40% to 100% to meet the needs of mother and fetus.~Feldt-Rasmussen et al., 2011

“The availability of THs (thyroid hormones) is critical for brain development. A growing body of clinical and experimental evidence indicates that even slight decreases in serum [blood] levels of THs can have significant consequences on brain development.” ~Nucera, 2010, emphasis added

This story is about you. Of course, it’s all about you, just as it should be—particularly if you are of child-bearing age. You are so very important. You will influence the quality of the next generation. But how did you get to this point? You somehow made your way inside of someone named Mom, and went from one cell to what ended up being trillions upon trillions of cells— complex cells—and by the strategic use of one very important hormone. So let’s see how you arrived on the scene.

Let’s start with you, the “one-cell” creature you—and at a time when you were so small that you could barely be seen by the naked eye. You started out as one big cell, the biggest cell the human body will ever make. You, in the form of a single cell, were probably created by your mother even before she herself was born! Then, at just the right time in her life you were released and sent on an incredible journey to find another cell, one that wiggles a lot when it gets excited. This stage did not last long! You soon became one big fertilized egg. Boy, you have no idea what it will take to develop into that lovely person you will become, the one that will have a tough time finding enough nice words to say about this wonderful and kind author. What you will do next, as you proceed from one cell to around 100 trillion of cells, is nothing short of a miracle.

As you progress beyond the initial stage of existence, you won’t waste any time or money downloading the necessary developmental programs—they are already there inside of each cell, but you will need to activate them, and activate them in a precisely controlled fashion. You will use thyroid hormone to activate, as needed, a myriad of timed genetic programs that will make you, cell-by-cell, one of the greatest creatures that has ever set foot on planet earth . . . wearing diapers! Since thyroid hormone, then and now, is intimately involved in the initiation and control of genetic events, and since you are a genetic event—actually, an ongoing genetic event—you will still need this hormone to be in adequate supply (or else!).

Well, that was quick! Now you are here, all grown up, and with a little reading assignment directly in front of you. It wasn’t easy, but you seemed to breeze right through this developmental business, out of diapers (we hope) and into moderately seductive attire. Later, if we have the time, we’ll go into exacting detail on how the growth and developmental process occurs. But now, of course, you are responding to the urge to “replicate,” rather frequently, I might add. With respect to “replication,” you will put thyroid hormone to good use here, too. You will need energy to get this whole thing off the ground (if you know what I mean)! Thyroid hormone means energy. It participates in the energy production that occurs within the cell. In addition, you will need thyroid hormone in adequate supply to pass on to the one who will call you home for approximately nine long months. For a good portion of your pregnancy, you will be the only source of thyroid hormone for the little someone who will be continuously developing inside (and developing at an incredible rate). Your baby’s little thyroid gland will pitch in to help (a little) around mid-gestation, but, overall, he or she will still require your thyroid hormone contribution in order to continue to develop properly (Morreale de Escobar et al., 2004). And during the entire pregnancy, you will be your baby’s only source of iodine, the element he or she will need in order to manufacture thyroid hormone, too, just like mommy. See, even when there is someone living and developing within, it is still all about you. Will you be able to deliver on the unspoken promise to provide all that is necessary for the one who is counting on you?

But your baby isn’t the only one at risk should your thyroid hormone status be inappropriate during your pregnancy, you are at risk, too. Your risk of placental separation and preterm labor is elevated when thyroid hormone is in short supply (Casey et al., 2005; Román et al., 2013). All of this, of course, places both you and your baby in jeopardy. So while it is all about you it is all about your baby, too. You are both in this together. You could lose your baby, you could even lose your life, simply due to an undetected and unresolved thyroid hormone issue (Hall, 2009; Tudosa et al., 2010, Wang et al., 2011). And don’t think that fetal loss and maternal loss do not occur in this day and age. They do. So, while I am deeply concerned about your baby, so much so that I wrote a certain little book, you can understand why I am also deeply concerned about you.

Diagnosing maternal thyroid dysfunction during all states of pregnancy is very important for the outcome for both mother and fetus. (Feldt-Rasmussen et al., 2011)
© 2014, Eugene L. Heyden, RN
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View the videos featured in Preventing Birth Defects: Understanding the Iodine/Thyroid Hormone Connection

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—Case finding approach misses most cases of thyroid disease during pregnancy





†Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG 2005
Subclinical Hypothyroidism and Pregnancy Outcomes. Obstet Gynecol; February; 105(2):239–
†Feldt-Rasmussen R, Mortensen A-S B, Rasmussen AK, Boas M, Hilsted L, Main K 2011
Challenges in Interpretation of Thyroid Function Tests in Pregnant Women with Autoimmune
Thyroid Disease. Journal of Thyroid Research Aritcle ID 598712 doi:10.4061/2011/589712
†Hall DR 2009 Abrupto Placentae and Disseminated Intravascular Coagulopathy. Semin
Perinatol 33:189–195Lockwood CJ 2013 Should Pregnant Women Receive Iodine Supplementation?
†Morreale de Escobar G, Obregón MJ, Escobar del Ray E 2004 Role of Thyroid Hormone
during Early Brain Development. European Journal of Endocrinology 151:U25–U37
Nucera C 2010 Maternal Thyroid Hormone Action during Embryo-Fetal Development. Hot
Thyroidology ( HT 11/10
†Román GC, Ghassabian A, Bingers-Schokking JJ, Jaddoe V, Hofman A, de Rijke YB, Verhuslt
FC, Tiemeier H 2013 Association of Gestational Maternal Hypothyroxinemia and Increased
Autism Risk. Ann Neurol 74:733–742
†Tudosa R, Vartej P, Hornoianu I, Ghica C, Mateescu SM, Dumitrache I 2010 Maternal and
Fetal Complications of the Hypothyroidism-Related Pregnancy. Maedica 5(2):116–123
†Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, Zhou J, et al 2011 The Prevalence of Thyroid
Disorders during Early Pregnancy in China: The Benefits of Universal Screening in the First
Trimester of Pregnancy. European Journal of Endocrinology 164:263–268

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