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Lecture Notes - Endocrinology > Endocrine Disorders of Pregnancy > Flashcards

Endocrine Disorders of Pregnancy Flashcards

1
Q

What can use an increased serum “total” T4 and T3 levels

A

increase in serum T4 binding globulin production caused by elevated oestrogen levels

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2
Q

Why do thyroid hormone requirements increase during pregnancy

A

Increased weight
placental deiodinase activity
transfer of T4 to the foetus

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3
Q

Maternal TSH does not cross the placenta. True or false

A

True

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4
Q

What thyroid hormones cross the placenta

A

T3 and T4

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5
Q

At what stage of development does metal TSH appear

A

around the 10th week of gestation

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6
Q

What are the thyroid hormones important for in development

A

Cognitive development during early pregnancy

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7
Q

What is hypothyroidism in pregnancy associated with

A 
early pregnancy loss 
placental abruption
pre-eclampsia 
preterm delivery 
low birth weight 
perinatal mortality 
neuropsychological impairment
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8
Q

What is the ideal TSH level in hypothyroidism which has been diagnosed before pregnancy

A

TSH level of less than 2.5mU/L

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9
Q

What are hypothyroid patients unable to do

A

increase their T4 and T3 secretion

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10
Q

What should the dose of levothyroxine be increased by and when

A

30-50% by 4-6 weeks gestation

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11
Q

What are further dose changes of levothyroxine based upon

A

serum TSH concentrations

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12
Q

How often should serum TSH be measured

A

4-6 weeks after conception
4-6 weeks after any change in the dose
at least once each trimester

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13
Q

What should happen to the dosage of levothyroxine after delivery

A

it should be reduced to pre-pregnancy levels

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14
Q

What is poorly controlled hyperthyroidism in pregnancy associated with

A 
Pregnancy loss 
premature labour 
low birth weight 
pre-eclampsia 
maternal cardiac failure
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15
Q

Why is it difficult to diagnose hyperthyroidism during pregnancy

A

many of the symptoms are similar to the non-specific symptoms associated with pregnancy

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16
Q

What is the diagnosis of hyperthyroidism in pregnant women made

A

based primarily on a serum TSH less than 0.01mU/L and a high serum free T4 and or free T3

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17
Q

What is helpful in making the diagnosis of Graves’ disease during pregnancy

A

Measurement of TSH-receptor antibodies (TRAbs)

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18
Q

What should Hyperthyroidism due to Graves’ disease or hyper functioning thyroid nodules be treated with

A

antithyroid drugs

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19
Q

When might a subtotal thyroidectomy be indicated in hyperthyroid women during pregnancy

A

women who cannot tolerate antithyroid drugs because of allergy or agranulocytosis

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20
Q

When is the optimal timing of surgery

A

second trimester

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21
Q

Why do some neonates born to women with Graves’ disease have hyperthyroidism

A

due to the transplacental transfer of TSH receptor stimulating antibodies

22
Q

What is hyperemesis gravidarum characterised by

A

nausea
vomiting
weight loss
all during early pregnancy

23
Q

Describe the levels of T4 and T3 in hyperemesis gravidarum

A

Serum free T4 is minimally elevated and serum T3 is usually not elevated

24
Q

What is the treatment for hyperemesis gravidarum

A

Nothing - it resolves as hCG production falls
IV fluids
anti-emetics and nutritional support

25
Q

What can cause thyroid enlargement

A

iodine depletion (due to increased maternal renal clearance and metal uptake of iodine )

26
Q

What do women with malignant or suspicious cytology require

A

surgery

27
Q

What do prolactinomas usually result in

A

infertility due to the inhibitory effect of prolactin on gonadotrophin secretion

28
Q

What are patients with microprolactinomas treated with

A

dopamine agonist prior to pregnancy

29
Q

When is a dopamine agonist discontinued

A

as soon as pregnancy has been confirmed

30
Q

What should be given to a patient with a macroprolactinoma in order to shrink the tumour prior to pregnancy

A

Cromocriptine or cabergoline

31
Q

Why is breast feeding contraindicated in women who have neurological symptoms at the time of delivery

A

They should be treated with a dopamine agonist

32
Q

Describe the effect of Addison’s disease in pregnancy

A

The foetus produces and regulates its own adrenal steroids

Therefore, pre-existing primary adrenal insufficiency in the mother is not associated with metal morbidity

33
Q

Describe the changes of treatment in a pregnant woman with Addison’s to a non-pregnant woman

A

They are the same

34
Q

What should be given at the time of delivery in a patient with Addison’s and why

A

high dose IM hydrocortisone to cover the stress

35
Q

How might Addison’s disease that has developed in pregnancy present

A

adrenal crisis particularly at time of delivery

36
Q

What is the main sign of phaeochromocytoma

A

Hypertension
paroxysmal headache
sweating
palpitation

37
Q

How is the diagnosis of phaeochromocytomas in pregnancy made

A

3 24 hour urine collections for the measurement of catecholamines and fractionated metanephrines
MRI is use for localisation of tumours after confirmation of the diagnosis

38
Q

What is the treatment for a phaechoromocytoma in a pregnant woman

A

phenoben`amine (alpha blocker) 10mg BD and increased gradually

39
Q

What is gestational diabetes mellitus

A

glucose intolerance with an onset or first recognition during pregnancy

40
Q

What results in the maternal insulin resistance in gestational diabetes

A

Increased placental secretion of diabetogenic hormones such as growth hormone, corticotrophin-releasing hormone, human placental lactogen and progesterone

41
Q

Why does gestational diabetes occur in some women

A

pancreatic function cannot overcome both the insulin resistance created by these anti-insulin hormones and the increased fuel consumption necessary to provide for the growing mother and foetus

42
Q

How is gestational diabetes diagnosed

A

a 75mg 2 hour oral glucose tolerance test

43
Q

What else should be tested during routine prenatal testing during an assessment of women with diabetes

A 
measurement of glycated haemoglobin 
urea 
creatinine and electrolytes 
TSH 
free T3 
ECG
44
Q

What is meant by medical nutritional therapy

A

3 meals and 3 snacks a day

40% carbs, 40% fat and 20% protein

45
Q

How often should patients check their blood glucose

A

upon awakening and 1 hour after each meal to evaluate the effectiveness of the medical nutritional therapy

46
Q

What is the goal of insulin therapy

A

a fasting blood glucose of less than 5mmol/L

47
Q

What is poorly controlled diabetes in the first trimester associated with

A

Miscarriage and congenital malformations

48
Q

When might earlier delivery be warranted

A

in the presence of high risk factors such as worsening retinopathy or nephropathy
poor control
pre-eclampsia or restricted metal growth

49
Q

What are women with gestational diabetes at an increased risk of developing

A

diabetes after pregnancy

50
Q

What might worsen in diabetics during pregnancy

A

diabetic retinopathy

51
Q

How often should diabetic patients be screened for diabetic retinopathy in pregnancy

A

during the first trimester and then every 3 months

52
Q

What can be carried out safely during pregnancy if required in diabetic retinopathy

A

Laser therapy and virtuous surgery

Lecture Notes - Endocrinology (40 decks)

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