Autoimmune thyroid disorders such as Graves' disease or Hashimoto's thyroiditis are most likely to strike during the first trimester of a pregnancy and within the first six months after delivery, or in the postpartum (right after childbirth) phase. It's normal for the thyroid gland to enlarge slightly during pregnancy because the placenta makes a hormone, human chorionic gonadotropin (HCG), that stimulates the mother's thyroid gland. Researchers have found that HCG has portions that share a very similar molecular structure to TSH (thyroid stimulating hormone). Situations that increase TSH levels often stimulate the enlargement of the thyroid gland (goiter). Likewise, the great increase in HCG seen in pregnancy affects the thyroid gland in a similar fashion, working like TSH to cause some enlargement of the thyroid gland. It is possible that this is part of the complex assortment of factors that help induce autoimmune thyroid problems.
During pregnancy, the immune system is naturally suppressed in some ways to prevent the body from rejecting the fetus. After pregnancy, the immune system "turns on" again. But this may have a rebound effect in that it may result in the production of antibodies that attack normal thyroid tissue, which is what occurs in autoimmune thyroid disease. This may be one reason why women are more prone to autoimmune disorders after pregnancy. Thyroid disease in pregnancy is discussed more in Chapter 13.
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