Endocrinopathies in Pregnancy Flashcards
At how many weeks do the foetal thyroid follicles and thyroxine synthesis occur
10 weeks
The maternal T4 regulates what processes for the foetus?
Neurogenesis, migration and differentiation
In pregnant women with normal thyroid function, there is increased __ and __ production resulting in inhibition of TSH
T3 and T4
What causes the high T3 and T4 levels in pregnant women with normal thyroid function?
High human chorionic gonadotropin (hCG) level that stimulates the TSH receptor because of partial structural similarity
What contributes to higher thyroxine requirements in pregnancy?
Increased thyroid metabolism, high levels of hepatic production of thyroxine-binding globulin (TBG) and large plasma volume so altered distribution of thyroid hormone.
True of false: Biochemical thyroid function should be total hormone?
No, should be free thyroid hormone as total hormone will show more than normal value when the patient is euthyroid (normal thyroid function)
Glycoprotein hormones contain 2 subunits, a common _ subunit and a distinct _ subunit
alpha, beta
Name some glycoprotein hormones
TSH, LH, FSH and hCG
Signs of hypothyroidism in pregnancy
Weight gain, cold intolerance, poor concentration, poor sleep pattern, dry skin, constipation, tiredness
What can hypothyroidism in pregnancy cause?
Inadequate treatment
Gestational hypertension
Placental abruption
Post partum haemorrhage
Low birth weight
Preterm delivery
Neonatal goitre
Neonatal respiratory distress
Pregnant women with hypothyroidism require a dose increase in their ____ during pregnancy
thryoxine
how does hyperthyroidism effect pregnancy?
IUGR (Intrauterine growth restriction)
Low birth weight
Preeclampsia
Preterm delivery
Risk of stillbirth
Risk of miscarriage
True or false: Hyperthyroidism tends to worsen in the first trimester
True, it then improves in latter half of pregnancy
How would you treat a pregnant women with Graves’ disease?
PTU rather than carbimazole (can give baby aplasia cutis)
Don’t give radioiodine
Repeat blood tests
Gestational Transient Thyrotoxicosis
Due to HCG, raised T4, low TSH.
Absence of thyroid autoimmunity
Limited to first half of pregnancy.
Thyrotoxicosis risks
In gestational thyrotoxicosis, symptoms ___ predate pregnancy
don’t
Gestational thrytoxicosis don’t have a…
goitre with bruit
Who is at high risk of post partum thyroiditis?
Type 1 diabetics
Graves’ disease in remission
Chronic viral hepatitis
Microprolactinoma
Common, lesion sits in pituitary. Can cause hypogonadism, switches off periods. Give drug cabergoline, taken off when pregnant
Pituitary Macroadenomas
Anything over 10mm in pituitary.
Diabetes insipidus can worsen as a result of placental vasopressinase production and reduction in ___
ADH
Acromegaly is uncommon
Cushing’s syndrome features
weight gain, gatigue, myopathy, fractures, hyperandrogenism, hirsuitism, acne
Adrenal insufficiency in pregnancy
Nausea, vomiting, weakness, hyponatraemia, weight loss, hyperpigmentation and greater magnitufe of hyponatraemia
Amiodarone
Iodine rich often used to treat atrial fibrillation and for ventricular arrhythmias.
Side effects = skin becomes pigmented slate grey if sit in sun, pulmonary, GI, opthalmic, neruologic, dermatologic and thyroid problems.
Amiodarone Induced Thyrotoxicosis Type 1
Latent pre-existing
Low iodine areas
Iodine induced excess
Thyroid hormone release
Amiodarone Induced Thyrotoxicosis Type 2
Normal thyroid
Destructive
What drug is used for advanced melanoma?
Ipilimumab (monoclonal antibody, activates immune system by inhibiting CTLA-4 which normally downregulates immune system. Target CTLA-4 to keep T cell active to destroy cancer cells.
Ipilimumab Hypophysitis (IH)
