CBL 6 – Thyroid and Hypertension Flashcards
Who do we screen for thyroid (risk factors)?
- > 30 yrs
- 2 prior preg
- Hx PTL, infertility, loss
- T1DM/ Celiac /Auto-immune
- BMI >/=40
- Hx thyroid disease
- Family Hx of thyroid disease
- Goitre
- Taking meds for thyroid
What is normal thyroid levels in T1 for someone with prev thyroid disease?
0.1-4
What is the normal thyroid levels in T1 for someone with no prev thyroid disease?
0.1-5.0
What is subclinical hypothyroidism?
Elevated TSH normal T4
What are clinical symptoms and values of hyperthyroidism?
low TSH, high T3/T4
high energy, weight loss, tremor, hot, agitated mood
What are clinical symptoms and values of hypothyroidism?
high TSH, low T3/T4
low energy, tired, depressed mood, weigh gain, getting cold easily
What is thyroid storm?
Massive dump of T4/T3
When is thyroid storm more likely?
after surgery, infection, or after birth (postpartum)
What does a thyroid storm look like?
tachy, extreme irritability, cardiac event if not managed.
What is the thyroid feedback loop?
Pit releases TSH -»T3 and T4 -» more TSH/less TSH
How much dietary iodine recommended per day?
150 mcg
Perinatal complications hyperthyroidism?
Pre-eclampsia
PTL
Thyroid storm
IUGR
LBW
Fetal demise
Perinatal complications hypothyroidism?
Hypertension
Preeclampsia
Anemia
Miscarriage
PTB
PPH
LBW
Stillbirth
What should you avoid with levothyroxine?
Fe and Ca
Numbers needed for levothyroxine Rx?
TSH >=10
What is the leading cause of maternal morbidity worldwide?
HDPs
What are HDPs classified as? (4)
Chronic hypertension
Gestational hypertension
Preeclampsia
White coat hypertension
What is considered hypertension?
Systolic >=140
Diastolic >=90
Which part of BP is more concerning with hypertension?
Persistently high diastolic
What is severe hypertension?
Systolic >=160
AND/OR
Diastolic >=110
What is the criteria for pre-eclampsia?
Hypertension
AND one or more:
- Maternal organ dysfunction
- Fetal growth restriction
Criteria for Eclampsia?
Hypertension
Same as pre-eclampsia
Seizures with no known origin
Symptoms hypertension involving organ systems?
CNS –
Headaches
Flashing lights
Blind spots
Irritability
Hyperreflexia
CVS
Chest pain
Dyspnea (shortness of breath)
Distended neck veins
Liver
RUQ pain
Epigastric pain
Nausea / Vomiting
Kidney
Proteinuria
Oliguria
Edema (no longer part of criteria though – not specific enough)
Placenta
IUGR
Symptoms of gestational hypertension?
RUQ pain
Headaches
Visual dist
Risk factors for hypertension?
Obesity
Diabetes
Existing renal disease
Chronic hypertension
Prior preclampsia
Family Hx preeclampsia, gest hypertension
Carrying multiples
ART
New partner
Abnormal genetic screening analytes
Nulip
>40 yo
Symptoms of pre-eclampsia?
Headache
Visual disturbances
Vomiting
Symptoms of HELLP?
Epigastric pain
Platelet type bleeding
Jaundice
Symptoms of Eclampsia?
Seizures
What are the 4 principles of managing hypertension?
Evaluate well being of fetus/birther
Prevent severe complications
Manage symptoms
Expedite delivery
Proper BP reading to confirm hypertension?
Blood pressure should be taken with the client in a
sitting position, with an appropriate sized cuff, and the
upper arm at the level of the heart.
* If blood pressure is elevated, take two readings with a
minimum rest period of 15 minutes between.
What tests if hypertension? (5)
CBC
Creatinine
ALT/AST
Urine protein: UPCR, 24 hour urine (which people don’t do cuz it’s gross)
Assessment of fetal well being: growth, doppler, fluid
What is the most significant distinguishing feature of preeclampsia vs hypertension?
Presence of proteinuria W hypertension
What is proteinuria defined as?
> = 300 mg/day 24 hour urine collection
2+ on dipstick
UPCR <30
Steps if proteinuria?
Consult OB
NST
What is done in management of eclampsia?
Magnesium sulfate
Expedite delivery real fast
TRANSFER CARE
What can reduce HDP? (5)
Low dose ASA
Calcium
Vit D
Exercise
Dietary advice
Who should take low dose ASA in preg?
Prior pre-eclampsia
BMI >30
Chronic hypertension
Diabetes before preg
Kidney disease
Lupus
ART
2 or more:
Placental abruption
Prior stillbirth
Prior IUGR
>40
Nulip
Multifetal preg
What are some possible hypertensive meds?
Labatalol 100-200 mg TID
Nifedipine 20 mg BID
Methyldopa 250 mg TID
IOL for chronic hypertension?
Consider 37-38
Def by 40
immediate if unable to control BP >12 hours
IOL for gestational hypertension?
Consider 37-38
Def by 40
immediate if unable to control BP >12 hours
Preclampsia IOL?
(36-36+6) delivery should be considered - if stable
<24 should be considered
If BP cannot be controlled, increased organ dysfunction, or fetal indication - any GA
How much ASA?
81-162 mg starting before 16 wks to 36 wks
What is the purpose of controlling BP for HDP?
Decreasing the chance of maternal stroke
Who should take calcium with ASA?
Only those people who don’t get enough dietary Ca intake
What should be considered with transport for HDPs?
-maternal BP stable
-seizure prophylaxis given
-skilled HCP accompany to admin meds
What is recommended PP for people with HDPs?
Monitoring of BP first 2 weeks of pp
BP checked again at 6 wks pp
