Thyroid and parathyroid disease Flashcards
Physiological thyroid facts
TBG increased
Overall T3/4 increased
Biochemical hyperthyroidism due to hyperemesis in 60% of cases
Relative iodine deficiency state (increased to baby, urine, thyroid)
Differentiating from hyperthyroidism sx to early pregnancy
Cause of hypothyroidism and its AB
Tremor, tachycardia, lid lag, weight loss, exophthalmos
Graves 95% and TSH Receptor stimulating AB
Effect on pregnancy
Pregnancy effect on disease
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
Drugs:
PTU
Carbimazole
BB
Other
Thyroidectomy and radioactive iodine
PTU rare liver failure, less crossing the placenta to cause fetal hypothyroidism/goitre
Carbimazole: aplasia curtis
Neutropenia and agranulocytosis
B blockers are safe
Neonatal effects of thyroid disorders
Hyperthyroidism:
TRAb: thyrotoxicosis, tachycardia, FGR
Hypothyroidism
- Neonatal hypothyroidism is rare, may occur due to transplacental TSH receptor-blocking antibodies
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
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
Postpartum thyroiditis
Increased risk with thyroid peroxidase antibodies
More common with type 1 diabetes
Ca2+ needs in pregnancy
Increased demand
Increased loss urinary ca2+
Need two fold vit D
Primary hyperparathyroidism
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
Hypoparathyroidism:
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
Vitamin D deficiency
Causes: bone loss, hypocalcaemia, osteomalacia, myopathy, GDM, HTN, PET, IUGR, CS
Fetal bone health, tetany, asthma, atopy,