Thyroid Disease in Pregnancy

Question 1

Can iodine be used in pregnancy and breastfeeding?

Answer 1

1. No, contraindicated for both.

2. Contraceptive for 4 months after using iodine.

Question 2

When should any necessary thyroid surgery be scheduled for in pregnancy?

Answer 2

Second trimester

Question 3

How frequently should TFTs be tested in hyperthyroidism, hypothyroidism, and postpartum thyroiditis?

Answer 3

1. Monthly
2. 6-weekly
3. Monthly

Question 4

What treatment is used in pregnancy for hyperthyroidism?

Answer 4

Propylthiouracil (carbimazole can cause foetal aplasia cutis and imperforate nasopharynx)

Question 5

What should be monitored in mothers on thionamides?

Answer 5

Neonatal TFTs

Question 6

Which aspects of pregnancy can precipitate a thyroid storm?

Answer 6

Labour, delivery, surgery

Question 7

How is hypothyroidism treated in pregnancy?

Answer 7

Replace with T4 (doses may need to be increased due to normal reduction of T4 in pregnancy)

Question 8

What is post-partum thyroiditis?

Answer 8

Hyperthyroidism followed by hypothyroidism

Question 9

How is post-partum thyroiditis treated?

Answer 9

1. Self-limiting and does not need thionamides
2. Beta blockers if symptomatic
3. Treat hypothyroid phase if symptomatic