May 6, 2016 - Abnormal TSH in Pregnancy

Question 1

TSH / hCG and Pregnancy

Answer 1

TSH drops initially peaking at a low around 10 weeks.

hCG spikes at this time.

Question 2

Grave’s Disease

Answer 2

An autoimmune disease that affects the thyroid. Frequently results in and is the most common cause of hyperthyroidism and often results in an enlarged thyroid.

Question 3

Management of Hyperthyroidism in Pregnancy

Answer 3

Radioiodine is absolutely contraindicated.

Propylthiouracil (PTU) or Methimazole are treatment options but carry small risks of fetal abnormalities.

Question 4

Methimazole Embryopathy

Answer 4

Aplasia cutus (hole in head)

Ompalocele (intestines form outside of abdominal wall)

Choanal atresia (back of nasal passage is blocked)

Esophageal atresia (esophagus is blocked)

Question 5

TSH Levels and Harm to Pregnancy

Answer 5

Harm to pregnancy can occur if TSH levels are >5

Levels may be outside the normal range, but as long as they aren’t above 5, this isn’t particularly concerning. Observe them.

Question 6

Postpartum Thyroiditis

Answer 6

A phenomenon following pregnancy that may involve hyperthyroidism, hypothyroidism, or the two sequentially.

It affects about 5% of all women within a year after giving birth. With diabetes, it reaches about 25%.

Often has hyperthyroidism for 2-4 months before becoming hypothyroid for 5-8 months because of the damage.