Thyroid disease and pregnancy Flashcards
what is more common in young women , hyper or hypothyroidism
*-what to look out for
hypothyroidisim more common
*be aware of women who were once hyper but since treatment are now hypo as management differs slightly
when does fetal thyroid gland become functional
*what is thyroxine essential for
12 weeks beofre then releiant on mother
*-thyrozxine essential for neurodevelopmetn
how do a pregnant womens iodine requiremnts differ
iodine losses through urine and feto-placental unit contribute to state of relative iodine deficiency
-pregantn women reuiqred additional iodine intake
how does pregnancy affect thyroid funtion 2
total thyroid hormone concentration in blood increased in pregnancy
-partly due to high levels of oestrogen and due to weak thyroid stimulating effects of human chorionic gonadotropin (hCG) that acts like TSH
Thyroxine (T4) levels rise about 6-12 weeks and peak mid gestation
whenn does a fetal thyroid gland function independently
from 12 weeks
conseuwenecs of suboptimal thyrdoid dysfunction treatmetn 3
mainly in first trimester
abnormal neurospych development
-loss of 4-7 IQ points
miscarriage and stillbirth
Mx of hypothyroidism in pregnancy
if euthyroid at booking no need to increase dose at conception
monitor TFTs using pregnancy specific ranges in each trimester
most commonly cause of hyperthyroidism
90-95% graves disease
5%
-toxic adenoma
-toxic multinodual goitre
-subacute thyroiditis
-gestational hyprethyroidism
clinical features of hyperthyrodisim
pregnnacy mimics hyperthyrodism
-heat intolerance, palpitation, palmar erythema, goitre
how to discriminate hyperthyroidism from pregnnacy 4
weight loss
eye signs
pre-tibial myxoedema
tremor
effects of uncontrolled thyroidtoxicosis 4
increased
-miscrraige
-IUGR (intrauterine growth restirction)
-preterm delivery
-perinatal mortality
effcts of prengnacy on thyrodtoxicosis 3
often improves in 2nd and 3rd trimester
state of relative immunosuppression and fall in titre of TSH stimulating antibody
no effects of graves opthalmopathy
managemetn of hyperthrydoisim in pregnacy 3
carbimazole or propylthiouracil (PTU)
-use lowest effective dose as can potentially cause fetal suppression at high doses
B-bloack w propaolol
-monitor fetal growth
TFTs monthly
-check neonates TFTS regularly if mother breastfeeding
other options for hyperthyroidism managemnt in pregnancy 1
rarely surgey indicated
radioactive iodine contraindicated
presenatation of post partum thyroiditis 3
around 5-10% of all pregnancies
-occurs 1-3 months post partum
transient hyperthyroidisim-> subsequent hypothyroidismi (MAY BE CONFUSED FOR POSTPARTUM DEPRESSION) -> remits with resolution after 1 yr
