Endocrinopathies in Pregnancy

Question 1

At how many weeks do the foetal thyroid follicles and thyroxine synthesis occur

Answer 1

10 weeks

Question 2

The maternal T4 regulates what processes for the foetus?

Answer 2

Neurogenesis, migration and differentiation

Question 3

In pregnant women with normal thyroid function, there is increased __ and __ production resulting in inhibition of TSH

Answer 3

T3 and T4

Question 4

What causes the high T3 and T4 levels in pregnant women with normal thyroid function?

Answer 4

High human chorionic gonadotropin (hCG) level that stimulates the TSH receptor because of partial structural similarity

Question 5

What contributes to higher thyroxine requirements in pregnancy?

Answer 5

Increased thyroid metabolism, high levels of hepatic production of thyroxine-binding globulin (TBG) and large plasma volume so altered distribution of thyroid hormone.

Question 6

True of false: Biochemical thyroid function should be total hormone?

Answer 6

No, should be free thyroid hormone as total hormone will show more than normal value when the patient is euthyroid (normal thyroid function)

Question 7

Glycoprotein hormones contain 2 subunits, a common _ subunit and a distinct _ subunit

Answer 7

alpha, beta

Question 8

Name some glycoprotein hormones

Answer 8

TSH, LH, FSH and hCG

Question 9

Signs of hypothyroidism in pregnancy

Answer 9

Weight gain, cold intolerance, poor concentration, poor sleep pattern, dry skin, constipation, tiredness

Question 10

What can hypothyroidism in pregnancy cause?

Answer 10

Inadequate treatment
Gestational hypertension
Placental abruption
Post partum haemorrhage
Low birth weight
Preterm delivery
Neonatal goitre
Neonatal respiratory distress

Question 11

Pregnant women with hypothyroidism require a dose increase in their ____ during pregnancy

Answer 11

thryoxine

Question 12

how does hyperthyroidism effect pregnancy?

Answer 12

IUGR (Intrauterine growth restriction)
Low birth weight
Preeclampsia
Preterm delivery
Risk of stillbirth
Risk of miscarriage

Question 13

True or false: Hyperthyroidism tends to worsen in the first trimester

Answer 13

True, it then improves in latter half of pregnancy

Question 14

How would you treat a pregnant women with Graves’ disease?

Answer 14

PTU rather than carbimazole (can give baby aplasia cutis)
Don’t give radioiodine
Repeat blood tests

Question 15

Gestational Transient Thyrotoxicosis

Answer 15

Due to HCG, raised T4, low TSH.
Absence of thyroid autoimmunity
Limited to first half of pregnancy.
Thyrotoxicosis risks

Question 16

In gestational thyrotoxicosis, symptoms ___ predate pregnancy

Answer 16

don’t

Question 17

Gestational thrytoxicosis don’t have a…

Answer 17

goitre with bruit

Question 18

Who is at high risk of post partum thyroiditis?

Answer 18

Type 1 diabetics
Graves’ disease in remission
Chronic viral hepatitis

Question 19

Microprolactinoma

Answer 19

Common, lesion sits in pituitary. Can cause hypogonadism, switches off periods. Give drug cabergoline, taken off when pregnant

Question 20

Pituitary Macroadenomas

Answer 20

Anything over 10mm in pituitary.

Question 21

Diabetes insipidus can worsen as a result of placental vasopressinase production and reduction in ___

Answer 21

ADH

Question 22

Acromegaly is uncommon

Question 23

Cushing’s syndrome features

Answer 23

weight gain, gatigue, myopathy, fractures, hyperandrogenism, hirsuitism, acne

Question 24

Adrenal insufficiency in pregnancy

Answer 24

Nausea, vomiting, weakness, hyponatraemia, weight loss, hyperpigmentation and greater magnitufe of hyponatraemia

Question 25

Amiodarone

Answer 25

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.

Question 26

Amiodarone Induced Thyrotoxicosis Type 1

Answer 26

Latent pre-existing
Low iodine areas
Iodine induced excess
Thyroid hormone release

Question 27

Amiodarone Induced Thyrotoxicosis Type 2

Answer 27

Normal thyroid
Destructive

Question 28

What drug is used for advanced melanoma?

Answer 28

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.

Question 29

Ipilimumab Hypophysitis (IH)