Thyroid and Parathyroid Disease in Pregnancy Flashcards
Thyroid hormones in T1
Fall in TSH and rise in T4 expected
Free T4 falls with gestation
Hypothyroidism in pregnancy
as soon as pregnancy begins: thyroxine increase by 25ug
- repeat TFT in 2 weeks
- hopes to mimic normal rise in pregnancy
TFTs each trimester (or more often)
Most common form of hypothyroidism in developed world
Hashimotos
Aim for thyroid replacement therapy during pregnancy
continue, aim for biochemical euthyroidism (TSH<4)
Corrected hypothyroidism affect on pregnancy
none
Suboptimal thyroid replacement during pregnancy
Developmental delay and pregnancy loss
Hyperthyroidism in pregnancy
- Must be treated medically
Radio-iodine CI (obliterates fetal thyroid) - Monitor TFTs closely (many can reduce 1/3 can stop dose)
- Adjust dose PP
- anti-TSH-R can cross placenta so baby born to mother with positive titre reviewed by neonatology
Medical Mx of hyperthyroidism in pregnancy
carbimazole
propylthiouracil
Given at lowest possible dose
Why low dose Rx for hyperthyroidism in pregnancy
high dose may cross placenta (foetal hypothy.)
agranulocytosis (check WCC regularly)
Risks of uncontrolled thyrotoxicosis in pregnancy
risk miscarriage
PTD
FGR
PP thyroiditis Diagonsis
3 Criteria:
- <12 hours since birth
- manifestations suggest hypothroidism
- TFTs
3 stages of PP thyroiditis
thyrotoxicosis
hypothyroidism
normal function returns (high recurrence rate)
anti-TPO in PP thyroiditis
present in 90%
Mx of PP thyroiditis
Thyrotoxic: propranolol
hypothyroid phase: thyroxine
Hyperparathyroidism in pregnancy
- parathyroidectomy indicated in severe cases
- mild managed w/hydration and low Ca diet
