Thyroid Disease in Pregnancy Flashcards
What affect do hypo and hyper thyroidism have on the menstrual cycle
cause an anovulatory cycle which decreases fertility
what happens to thyroxine demand during pregnancy
it goes up
what affect does the increased demand on the thyroid have on the thyroid gland
increases in size
Increases T4 production
what happens to people with pre-existing hypothyroidism when they get pregnant
they’re unable to cope with the increasing demand on the thyroid
Need to up thyroxine as soon as pregnancy is suspected (by 25mg)
what happens when hypothyroidism is untreated in pregnancy
Increased abortion Pre-eclampsia Abruption post partum haemorrhage preterm labour
what effect does hCG have on the thyroid in pregnancy
stimulated the thyroid to produce thyroxine
This increase in thyroxine surpassed TSH
How can you distinguish hyperemesis from hypothyroidism
gestational hCG associated thyrotoxicosis resolves by 20 weeks (only treat if persists after this)
increased hCG and decreases TSH in hyperemesis gravid arum
what effects do hyperthyroidism have on pregnancy
Infertility spontaneous miscarriage Still birth Thyroid crisis in labour Transient neonatal thyrotoxicosis
Causes of thyrotoxicosis in pregnancy
Grave’s disease (most common)
Toxic multi-nodular goitre (more common in older women)
Thyroiditis
How to manage hyperthyroidism in pregnancy
wait and see - could be hyperemesis of pregnancy
if its graves it may settle as pregnancy suppresses autoimmunity
b-blockers
LOW DOSE anti-thyroid drugs
What anti-thyroid drugs are used in pregnancy
CARBIMAZOLE
- avoid in 1st trimester
- fine after then
PROPYLTHIOURACIL
- risk of liver toxicity
- try to avoid apart from maybe in 1st trimester
Why is it important to check for TRAb antibodies during pregnancy
TRAb antibodies can cross the placenta and causing neonatal transient hyperthyroidism
what is postpartum thyroiditis
transient hyperthyroidism then moves into hypothyroidism
hypothyroid stage associated with PND
will resolve at 12 weeks
