Thyroid disease Flashcards
Hyperthyroidism treatment
1st trimester: PTU
2nd/3rd trimester: methimazole
Both cross placenta
o give beta blockers only if symptomatic (not atenolol)
o radioactive iodine is contraindicated in pregnancy
Post partum thyroiditis
- Postpartum thyroiditis: destructive autoimmune disease resulting in hyperthyroidism then hypothyroidism
i) 6-8% of post partum women
ii) 80-85% of pts have thyroid antibodies (TPO and TgAB)
iii) most have a painless palpable goiter
iv) High risk women (ThAb+, type 1 DM, prior hx of this) do TSH at 3 and 6 months
Graves
Gets better in third trimester, can have exacerbation in first trimester and postpartum
o 1-5% of neonates have hyperthyroidism due to placenta transfer of TSH receptor antibodies
• even if mom has had radioactive iodine treatment, +’ve TSH receptor antibodies can still be present
• leads to tachycardia, goiter (may need C-section if prevents proper flexion + extension of neck), advanced bone age, IUGR, craniosynostosis
• neonatal graves mortality 20-25%
Post partum thyroiditis treatment
The hyperthyroid phase of postpartum thyroiditis, if symptomatic, is usually treated with a beta-adrenergic antagonist drug. Transient hypothyroidism is treated with T4, which may be continued for an arbitrary six months and then tapered to determine if the hypothyroidism is permanent. Beta blockers secreted in breast milk and can cause bradycardia but still considered good treatment
Methimazole fetal adverse effect
aplasia cutis / traceoesophageal fistula, choanal atresia
PTU fetal adverse effect
liver failure in pregnancy (cholestasis)
Oral prednisone
catergory C drug: increased risk of cleft palate (Palatal closure is usually complete by the 12th week of pregnancy, so potential risk would be limited to administration during the first trimester), gestational diabetes, hypertension and pre-mature rupture of membranes
• if patient on steroids >2 wks in past year, consider stress dose during labor
Montelukast
montelukast: class B drug = increased risk of PDA
