ENDOCRINE DISORDERS-THYROID DISORDERS 1.2 (AB)

Question 1

What is the primary imaging method for measuring fetal thyroid volume?

Answer 1

Sonography

Question 2

What are the fetal complications of hypo- or hyperthyroidism?

Answer 2

Hydrops, growth restriction, goiter, and tachycardia

Question 3

When should umbilical cord sampling be considered for fetal thyroid assessment?

Answer 3

When fetal goiter is present and fetal thyroid status is unclear

Question 4

What is thyroid storm?

Answer 4

A hypermetabolic, life-threatening condition in pregnancy

Question 5

What cardiovascular complications are associated with thyrotoxicosis?

Answer 5

Pulmonary hypertension, cardiomyopathy, and heart failure

Question 6

Why are pregnant women with thyrotoxicosis at risk for cardiac decompensation?

Answer 6

Minimal cardiac reserve, worsened by preeclampsia, anemia, or sepsis

Question 7

What is hyperthyroidism?

Answer 7

A condition of accelerated thyroid hormone biosynthesis and secretion

Question 8

What is thyrotoxicosis?

Answer 8

A clinical syndrome caused by elevated free thyroxine (FT4) and/or triiodothyronine (FT3) levels

Question 9

What is thyroid storm often precipitated by?

Answer 9

Surgery, trauma, or infection

Question 10

Where should thyroid storm management be carried out?

Answer 10

In an intensive care area within labor and delivery

Question 11

What are the first-line medications for thyroid storm management?

Answer 11

Beta-blockers (propranolol, labetalol, esmolol), iodine, and corticosteroids

Question 12

What is gestational transient thyrotoxicosis?

Answer 12

Hyperthyroidism due to TSH-receptor stimulation from hCG

Question 13

Are antithyroid drugs warranted in gestational transient thyrotoxicosis?

Answer 13

No

Question 14

What percentage of women with molar pregnancy have elevated T4 levels?

Answer 14

25-65%

Question 15

What causes hyperthyroidism in gestational trophoblastic disease?

Answer 15

Excess hCG overstimulating the TSH receptor

Question 16

What happens to serum free T4 levels after molar evacuation?

Answer 16

They rapidly return to normal, paralleling declining hCG concentrations

Question 17

What laboratory finding defines subclinical hyperthyroidism?

Answer 17

Low TSH with normal T4 levels

Question 18

What are the long-term effects of persistent subclinical thyrotoxicosis?

Answer 18

Osteoporosis, cardiovascular morbidity, progression to overt thyrotoxicosis

Question 19

Is subclinical hyperthyroidism associated with adverse pregnancy outcomes?

Answer 19

No

Question 20

Should subclinical hyperthyroidism be treated in pregnancy?

Answer 20

No, unless periodic surveillance indicates a need

Question 21

What are common symptoms of hypothyroidism?

Answer 21

Fatigue, constipation, cold intolerance, muscle cramps, weight gain

Question 22

What are two major causes of hypothyroidism?

Answer 22

Iodine deficiency and Hashimoto’s thyroiditis

Question 23

What physical exam findings are associated with hypothyroidism?

Answer 23

Enlarged thyroid, edema, dry skin, hair loss, prolonged relaxation phase of DTRs

Question 24

What defines overt hypothyroidism?

Answer 24

High TSH and low T4 levels

Question 25

What defines subclinical hypothyroidism?

Answer 25

High TSH with normal T4 levels

Question 26

What is the most common cause of hypothyroidism in pregnancy?

Answer 26

Hashimoto’s thyroiditis

Question 27

How does Hashimoto’s thyroiditis cause glandular destruction?

Answer 27

Autoantibodies (anti-TPO) attack the thyroid

Question 28

What treatment results in post-ablative hypothyroidism?

Answer 28

Radioactive iodine (RAI) ablation or thyroidectomy

Question 29

How is hypothyroidism treated?

Answer 29

Levothyroxine (LT4) replacement therapy

Question 30

What is the usual starting dose of levothyroxine in pregnancy?

Answer 30

1-2 µg/kg/day or 100 µg daily

Question 31

Why do athyreotic patients require higher doses of levothyroxine?

Answer 31

They lack functional thyroid tissue

Question 32

How often should TSH be monitored in pregnancy?

Answer 32

Every 4 weeks in the first half, once in the third trimester

Question 33

How should levothyroxine dosing be adjusted in pregnancy?

Answer 33

Increase by 25-50 µg increments to maintain TSH ~2.5 mU/L

Question 34

How does pregnancy affect levothyroxine requirements?

Answer 34

Estrogen increases demand, requiring higher doses

Question 35

What are potential complications of overt hypothyroidism in pregnancy?

Answer 35

Infertility, miscarriage, adverse perinatal outcomes

Question 36

How does iodine deficiency affect fetal thyroid function?

Answer 36

Leads to maternal and fetal hypothyroidism

Question 37

Can maternal TPO and anti-thyroglobulin antibodies affect fetal thyroid function?

Answer 37

No, they have little to no effect

Question 38

What is the prevalence of fetal hypothyroidism in mothers with Hashimoto’s thyroiditis?

Answer 38

1 in 80,000 newborns

Question 39

What factors influence the prevalence of subclinical hypothyroidism?

Answer 39

Age, race, dietary iodine intake, and serum TSH thresholds.

Question 40

What factors affect the progression of subclinical hypothyroidism to overt thyroid failure?

Answer 40

TSH level, age, diabetes, and presence/concentration of antithyroid antibodies.

Question 41

What did Diez and Iglesias (2004) find regarding TSH normalization in subclinical hypothyroidism?

Answer 41

Some TSH values became normal over 5 years.

Question 42

What is the progression rate to overt hypothyroidism for TSH levels between 10-15 mU/L?

Answer 42

19 per 100 patient years.

Question 43

What is the progression rate to overt hypothyroidism for TSH levels less than 10 mU/L?

Answer 43

2 per 100 patient years.

Question 44

What initial TSH level predicts overt hypothyroidism within 5 years in nonpregnant patients?

Answer 44

TSH >10 mU/L.

Question 45

What percentage of women developed thyroid disease in a 20-year follow-up of subclinical hypothyroidism during pregnancy?

Answer 45

0.03

Question 46

What percentage of women with subclinical hypothyroidism and thyroid antibodies developed thyroid disease in 20 years?

Answer 46

0.17

Question 47

How likely is the progression of subclinical hypothyroidism to overt hypothyroidism during pregnancy?

Answer 47

Unlikely in otherwise healthy women.

Question 48

What did 1999 studies by Haddow and Pop highlight?

Answer 48

Maternal thyroid dysfunction impacts fetal neuropsychological development.

Question 49

What pregnancy complications are associated with subclinical hypothyroidism (Casey et al., 2005)?

Answer 49

Preterm birth, placental abruption, NICU admissions.

Question 50

What did Cleary-Goldman et al. (2008) conclude about subclinical hypothyroidism and pregnancy outcomes?

Answer 50

No significant association with adverse outcomes.

Question 51

What risks are linked to subclinical thyroid dysfunction (Chen, 2017; Maraka, 2016)?

Answer 51

Adverse pregnancy outcomes.

Question 52

What increased risk was found in 24,883 women with subclinical hypothyroidism (Wilson et al., 2012)?

Answer 52

2x greater risk of severe preeclampsia.

Question 53

How does rising TSH affect gestational diabetes risk (Tudela et al., 2012)?

Answer 53

Increases the risk.

Question 54

What adverse outcomes are linked to subclinical hypothyroidism (Nelson et al., 2014)?

Answer 54

Increased risks of diabetes and stillbirth.

Question 55

What did the CATS Study (Lazarus et al., 2012) conclude about prenatal thyroid screening?

Answer 55

No improvement in offspring IQ at ages 3 and 9.

Question 56

What did the MFMU Network study (Casey et al., 2017) conclude about thyroxine therapy for subclinical hypothyroidism?

Answer 56

No difference in pregnancy outcomes or child cognitive development.

Question 57

What is the current recommendation for routine prenatal thyroid screening?

Answer 57

Not recommended for all women, only for high-risk women.

Question 58

What conditions warrant thyroid screening in pregnancy?

Answer 58

Personal/family history of thyroid disease, thyroid dysfunction symptoms, autoimmune disorders.

Question 59

How is isolated maternal hypothyroxinemia (IMH) defined?

Answer 59

Low free T4 with normal TSH levels during pregnancy.

Question 60

What is the incidence of IMH in large trials?

Answer 60

1.3%–2.1%.

Question 61

How does IMH differ from subclinical hypothyroidism?

Answer 61

IMH has a low prevalence of antithyroid antibodies.

Question 62

What early findings suggested neurodevelopmental impacts of IMH?

Answer 62

Cognitive and developmental delays (Pop, 1999, 2003; Li, 2010; Levie, 2018).

Question 63

What did Casey et al. (2007) find about IMH and perinatal risks?

Answer 63

No significant increase in perinatal risks compared to euthyroid women.

Question 64

What did the Consortium on Thyroid and Pregnancy (2019) find about IMH?

Answer 64

Higher risk of preterm birth.

Question 65

What did the CATS Study (Lazarus et al., 2012; Hales et al., 2018) conclude about thyroxine treatment in pregnancy?

Answer 65

No improvement in neurodevelopmental outcomes in children.

Question 66

What did the MFMU Network study (Casey et al., 2017) find regarding IMH treatment?

Answer 66

No benefit in pregnancy outcomes or child cognitive development.

Question 67

What is the consensus on treating IMH during pregnancy?

Answer 67

Routine treatment is not recommended.

Question 68

What organizations recommend targeted thyroid screening in pregnancy?

Answer 68

American Thyroid Association (2017), Endocrine Society (2017), ACOG (2020).

Question 69

What is euthyroid autoimmune disease?

Answer 69

Autoimmune attack on thyroid with normal thyroid function.

Question 70

What antibodies are associated with euthyroid autoimmune disease?

Answer 70

Anti-TPO and Anti-Tg antibodies.

Question 71

What pregnancy risks are linked to euthyroid autoimmune disease?

Answer 71

Early pregnancy loss, preterm birth.

Question 72

What did Negro (2006) find about levothyroxine in euthyroid autoimmune disease?

Answer 72

Reduced preterm birth risk from 22% to 7%.

Question 73

What iodine deficiency risks exist during pregnancy?

Answer 73

Lower fetal IQ, thyroid dysfunction.

Question 74

What are the recommended daily iodine intake levels during pregnancy?

Answer 74

220–250 µg/day.

Question 75

What percentage of Filipinos have thyroid dysfunction?

Answer 75

8.53% (higher in women, ratio 1.6:1).

Question 76

What is the primary cause of congenital hypothyroidism?

Answer 76

Thyroid gland developmental disorders (agenesis, hypoplasia).

Question 77

What is the key treatment for congenital hypothyroidism?

Answer 77

Early aggressive thyroxine replacement.

Question 78

What is postpartum thyroiditis?

Answer 78

Transient autoimmune thyroiditis occurring within the first year postpartum.

Question 79

What phases occur in postpartum thyroiditis?

Answer 79

Thyrotoxicosis (early) and hypothyroidism (late).

Question 80

What is the risk of permanent hypothyroidism after postpartum thyroiditis?

Answer 80

20%-30%.

Question 81

What is nodular thyroid disease?

Answer 81

Thyroid mass without hyper- or hypothyroidism.

Question 82

What is the malignancy risk of solitary thyroid nodules?

Answer 82

90-95% are benign.

Question 83

What imaging is used to evaluate thyroid nodules in pregnancy?

Answer 83

Ultrasound.

Question 84

When is thyroidectomy recommended for malignancy in pregnancy?

Answer 84

Second trimester or postpartum if non-aggressive.

Question 85

What is the function of parathyroid hormone?

Answer 85

Regulates serum calcium levels.

Question 86

What is the main cause of hyperparathyroidism in pregnancy?

Answer 86

Parathyroid adenoma.

Question 87

What symptoms indicate hyperparathyroidism?

Answer 87

Weakness, renal calculi, psychiatric issues.

Question 88

What is the treatment for symptomatic hyperparathyroidism in pregnancy?

Answer 88

Surgical removal of adenoma.

Question 89

What is hypoparathyroidism?

Answer 89

Deficiency of parathyroid hormone leading to hypocalcemia.

Question 90

What symptoms occur in hypoparathyroidism?

Answer 90

Tetany, muscle cramps, seizures.

Question 91

What is the main treatment for hypoparathyroidism?

Answer 91

Calcium and vitamin D supplementation.

Question 92

What is pregnancy-associated osteoporosis?

Answer 92

Bone loss during pregnancy leading to fractures.

Question 93

What factors increase the risk of pregnancy-associated osteoporosis?

Answer 93

Low BMI, multiple pregnancies, breastfeeding.