Thyroid and parathyroid disease Flashcards

1
Q

Physiological thyroid facts

A

TBG increased
Overall T3/4 increased
Biochemical hyperthyroidism due to hyperemesis in 60% of cases
Relative iodine deficiency state (increased to baby, urine, thyroid)

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2
Q

Differentiating from hyperthyroidism sx to early pregnancy
Cause of hypothyroidism and its AB

A

Tremor, tachycardia, lid lag, weight loss, exophthalmos
Graves 95% and TSH Receptor stimulating AB

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3
Q

Effect on pregnancy
Pregnancy effect on disease

A

Maternal: Infertility, miscarriage, arrythymia, thyroid storm and HF, retrosternal goitre
Fetal : FGR, PTB, perinatal mortality

Thyroid storm, may improve, worse in 1st trimester and postpartum

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4
Q

Drugs:
PTU
Carbimazole
BB

Other
Thyroidectomy and radioactive iodine

A

PTU rare liver failure, less crossing the placenta to cause fetal hypothyroidism/goitre

Carbimazole: aplasia curtis
Neutropenia and agranulocytosis

B blockers are safe

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5
Q

Neonatal effects of thyroid disorders

A

Hyperthyroidism:
TRAb: thyrotoxicosis, tachycardia, FGR

Hypothyroidism
- Neonatal hypothyroidism is rare, may occur due to transplacental TSH receptor-blocking antibodies

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6
Q

Hypothyroidism management
(generally secondary to AI destruction of gland eg atrophic thyroiditis or Hashimoto’s or iatrogenic tx’d Graves)

Effect on pregnancy

Effect on disease

A

Check for other AI disorders
Tx with levothyroxine
Test for thyroid autoantibodies

Pregnancy:
Infertility, miscarriage, anaemia, fetal loss, pre-eclampsia, LBW, PPH, developmental delay
Subclinical also seems to have increased effects but no evidence treatment improves outcomes.

Hypothyroidism:
unchanged, may need increases doses, worsening sx like constipation

Severe maternal iodine deficiency causes cretinism: deaf, spastic motor disorder, hypothyroidism

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7
Q

Postpartum thyroiditis

A

Increased risk with thyroid peroxidase antibodies
More common with type 1 diabetes

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8
Q

Ca2+ needs in pregnancy

A

Increased demand
Increased loss urinary ca2+
Need two fold vit D

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9
Q

Primary hyperparathyroidism

A

Causes: adenomas and hyperplasia
Sx: (2 to hypercalcaemia) fatigue, thirst, hyperemesis, constipation, depression, HTN, renal calculi, pancreatitis

Diagnosis: Ca when compared to albumin, PTH, USS

Pregnancy can improve it due to increased Ca2+ need
Risks of pancreatitis, hypercalcaemic crisis
Misc, IUFD, PTB, PET, HTN

Tx: surgery - delay under 2nd trimester

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10
Q

Hypoparathyroidism:

A

Cause: AI or iatrogenic
Sx:
Diagnosis: low Ca and PTH

Pregnancy means higher doses of treatment vitamin d and ca
Untreated 2nd miscarriage, fetal hypocalcaemia and hyperparathyroidism, neonatal rickets, neonatal hypocalcaemic seizures

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11
Q

Vitamin D deficiency

A

Causes: bone loss, hypocalcaemia, osteomalacia, myopathy, GDM, HTN, PET, IUGR, CS
Fetal bone health, tetany, asthma, atopy,

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