thyroid disease in pregnancy Flashcards
Physiological changes of Thydroid in preg
1st trimester- fall in TSH and Rise of T4 expected
will drop with advbmcing gestation
perform TFT at booking for
current thyroid, previous thyroid, 1st degree Fhx, AID conditions
Pre-conception and pregnant management of Hypothyroidism
Important- when begin increase thryxine by 25ug (even if well managed)
repeat TFT 2w after and repeat each trimester to adjust
Continue therapy-aim for euthyroidsm
if corrected well- no influence of preg
suboptimal - developmental delay and preg loss
Post partum management of Hypothyroidism (postpartum thyroiditis)
diagnosis on-
patient is <12m after delivert
clinical signs of hypothyroidism
TFT alone suggest
3 staegs - thyrotoxicosis -> hypothyroidism-> euthyroid
high reccurence rate- TFT measure every 2 m after thryrotoxic stage
Mx-
in thyrotoxic- propanolol
Hypothyroid- thyroxine
Hyperthyroidism in pregnancy
Treat medically (no surgery) at lowest dose of
Propylthiouracile (1st trimm)
Carbimazole (2nd and 3rd trim)
NO RADIOACTIVE IODINE
SE- foetal hypothyroidism- high dose can cross placenta – can stop treatment during preg
agranulocytosis
Thryrotoxicosis is bad- misscarage, PTL, IUGR
Hyperparathyroidism in pregnancy
Parathyroidectomy can be neeeded
if mild - adequate hydration and low Ca diet
risk- misscariage, PTL, tetamy
Hypoparathyroidism in pregn
Risk- increase risk of misscariage, foetal hypocalcemia, PTL
Mx- Vitmin D, oral CA supplementts
monitor Ca and Albumin
