endocrinology of pregnancy (thyroid)

Question 1

what happens in days 1-4 of period cycle

Answer 1

menstruation

Question 2

when does ovulation occur and what triggers it

Answer 2

day 15 - after LH surge

Question 3

when and what is the luteal phase

Answer 3

day 15-28, helps uterus prepare for pregnancy.

Question 4

what is the ovum and what does it secrete

Answer 4

egg - oestradiol

Question 5

what is the corpus luteum and what does it secrete

Answer 5

clump of cells made from follicle of released egg - progesterone

Question 6

what does an implanted fertilised ovum secrete

Answer 6

HCG - used in pregnancy test

Question 7

what does the placenta secrete

Answer 7

human placental lactogen (hPL), human progesterone, oestrogen

Question 8

what causes physiological response causes raised blood glucose in pregnancy and what will this cause some women to develop if predisposed

Answer 8

progesterone and hPL make mother slightly insulin resistant - can cause gestational diabetes

Question 9

what complications can occur in pregnancy due to diabetes (8)

Answer 9

malformation, premature, intra-uterine growth retardation, macrosomia (huge baby), polyhdramnios (excess fluid, fatal), spina bifida, caudal regression syndrome, ureteric duplications

Question 10

which pregnancy complication is almost exclusive to diabetes

Answer 10

caudal regression syndrome

Question 11

what complications can occur in newborns as a result of diabetes

Answer 11

resp distress, foetal hypoglycaemic + fits (hyperinsulinaemia)

Question 12

when does gestational diabetes present (GDM)

Answer 12

3rd trimester

Question 13

what management is given in diabetic mothers

Answer 13

sugar control and 5mg folic acid first 3 months of pregnancy

Question 14

what is given IV to diabetic mothers in labour

Answer 14

IV insulin and dextrose

Question 15

what drug treatment is given for T1DM, T2DM and GDM

Answer 15

1: insulin, 2: metformin (+insulin) 3: lifestyle (+metformin)

Question 16

when does GDM considered to be T2DM

Answer 16

if it doesn’t resolve after pregnancy

Question 17

what present of mothers who have GDM go in to develop T2DM

Answer 17

50%

Question 18

if pregnant and hypothyroidism what is done immediately

Answer 18

increase thyroxine by 25mg

Question 19

what risks are there in hypothyroidism and pregnancy to mother and baby

Answer 19

pre-eclampsia, abortion, preterm labour, neurological underdevelopment - babies have reduced IQ

Question 20

why is hyperthyroidism hard to diagnose in pregnancy

Answer 20

high HCG increases thyroxine (T4) which also lowers TSH

Question 21

what causes morning sickness in pregnancy

Answer 21

HCG

Question 22

why should ATD’s be held off in prescribing in pregnancy

Answer 22

do avoid malformation of baby

Question 23

what complications can occur in pregnancy with hyperthyroidism (5)

Answer 23

infertility, miscarriage, still birth, thyroid crisis, transient neonatal thyrotoxicosis

Question 24

how do you manage hyperthyroidism in pregnancy

Answer 24

wait as long as possible to prescribe ATDs, if you have too: PTU 1st trimester –> carbimazole

Question 25

what is post-partum thyroiditis

Answer 25

transient thyrotoxic –> hypothyroid

Question 26

what is post-partum thyroiditis associated with

Answer 26

post-partum depression

Question 27

in thyroid embryological development, what is a lingual thyroid caused by

Answer 27

failure to descend from foramen caecum - stays at back of tongue

Question 28

in thyroid embryological development, what is a retronsternal thyroid caused by

Answer 28

excessive descent