endocrine compliations c Flashcards
what does first trimester stimulate
progesterone estradiol and free estriol with human placental lactometer
metabolic changes with pregnancy
• Increased erythropoetin, cortisol, noradrenaline
• High cardiac output
• Plasma volume expansion
• High cholesterol and triglycerides
• Pro thrombotic and inflammatory state
• Insulin resistance
gestational syndrome associated with pregnancy
• Pre-Eclampsia
• Gestational Diabetes
• Obstetric cholestasis
• Gestational Thyrotoxicosis
• Transient Diabetes Insipidus
• Lipid disorders
• Postnatal depression
• Postpartum thyroiditis
• Postnatal autoimmune disease
• Paternal Disease
describe stages of thyroid gland development
• Fetal thyroid follicles and thyroxine synthesis occurs at 10 weeks
• Axis matures at 15-20 weeks
• Maternal T4 0-12 weeks regulates neurogenesis, migration and differentiation then fetal T4
describe glycoprotein hormones
they contain 2 subunits
- a common a subunit
- a distinct b subunit
what does hCG do to thyroid
can affect thyroid gland
suppresses TSH as the molecules are similar
prevalence of hypothyroidism in pregnancy
2-3%
symptoms of hypothyroidism predate pregnancy
- Weight gain
- cold intolerance
- poor concentration
- poor sleep pattern
- dry skin
- constipation
- tiredness
how does hypothyroidism affect pregnancy
• Inadequate treatment
• Gestational hypertension
• Placental abruption
• Post partum haemorrhage
• If untreated
• Low birth weight
• Preterm delivery
• Neonatal goitre
• Neonatal respiratory distress
what to do for hypothyroidism in pregnancy
• Preconception counselling ideal pre-conception TSH <2.5 mIU/L
• Increase dose by 30 %
• arrange TFT early preg and titrate
• women require a dose increase in their thyroxine during pregnancy
• If overt in pregnancy aim to
normalise asap
who do you give targeted screening to for hypothyroidism
• Age >30
• BMI >40
• Miscarriage preterm labour
• Personal or family history
• Goitre
• Anti TPO
• Type 1 DM
• Head and neck irradiation
• Amiodarone, Lithium or contrast use
prevalence of hyperthyroidism in pregnancy
0.1 - 0.4%
most common type of hyperthyroidism in pregnancy
graves disease
how does hyperthyroidism affect pregnancy
If inadequately treated:
• IUGR
• Low birth weight
• Preecclampsia
• Preterm delivery
• Risk of stillbirth
• Risk of miscarriage
how does pregnancy affect hyperthyroidism
• Tends to worsen in the first trimester
• Improves latter half of pregnancy
