Chapter 11: Hyperthyroidism in pregnancy

Question 1

S/S of hyperthyroidism

Answer 1

-heat intolerance
-diaphoresis
-fatigue
-anxiety
-emotional lability
-tachycardia
-wide pulse pressure
>weight loss, tachycardia greater than 100 bpm, and diffuse goiter (enlargement of thyroid gland)

Question 2

Thyrotoxicosis in Pregnancy

Answer 2

excessive thyroid activity
-GI symptoms: severe nausea, excessive vomiting, and diarrhea
-cardiomyopathy (An acquired or inherited disease of the heart muscle which makes it difficult for the heart to pump blood to other parts of the body)
-lymphadenopathy (lymph nodes become swollen in response to illness, infection, or stress)
-congestive heart failure
(can all accompany thyrotoxicosis)

Question 3

Diagnosis

Answer 3

• depressed maternal serum of TSH concentration
• elevated free thyroxine (T4) level
• use of radioactive iodine for diagnosis or treatment is contraindicated

Question 4

Treatment

Answer 4

• anti-thyroid medications (thioamides, propylthiouracil (PTU-drug of choice), or methimazole (Tapazole))
• symptomatic improvement within 2 weeks of therapy, but medication does not come fully effective until 6 to 8 weeks

Question 5

Interventions

Answer 5

• patients free T4 levels are obtained on a monthly basis and findings are used to taper the dosage to achieve smallest effective level to prevent unnecessary fetal hypothyroidism
• when unresponsive to drug therapy, surgery may be necessary; but performed only in severe cases of hyperthyroidism
• assess maternal pulse rate (less than 100 bpm)
• assess reflexes (2+ to 3+)
• assess weight gain and fetal growth

Question 6

Complications of anti-thyroid therapy

Answer 6

purpuric skin rash, pruritis (itchy skin), fever, and nausea

Question 7

Dietary Needs

Answer 7

increased calories and protein