Thyroid Disease in Pregnancy

Question 1

What type of thyroid disease does pregnancy mimic?

Why does this happen?

Answer 1

Hyperthyroidism:

• Tachycardia
• Warm moist skin
• Small goitre

Raised beta-hCG levels mimics TSH

Question 2

Pre-pregnancy hyperthyroidism:

What type of Rx is CI in pregnancy?

How might hyperthyroidism be of concern?

Answer 2

Radioactive iodine Rx - you shouldn’t

Infertility

Question 3

Hyperthyroidism:

What does it increase the risk of in pregnancy?

What is TRA-b?

What can increase the levels of TRA-B cause in the foetus?

Answer 3

Prematurity
Fetal loss
Malformations

TSH-receptor stimulating antibodies

Fetal thyrotoxicosis:

• Prematurity
• Goitre - so polyhydramnios
• Extended neck in labour
• Fetal tachycardia

Question 4

Hyperthyroidism - EMERGENCY

What may cause a thyroid storm?

What are some of the S+S of this?

Answer 4

Labour
Delivery
Surgery
Anaesthesia

Fever 
Tachycardia 
Agitation 
Psychosis 
Coma

Question 5

Hypothyroidism:

If it is left untreated, what is it associated with?

How may it affect a child?

Treatment?

Monitoring?

Answer 5

Infertility 
Oligo/menorrhoea
Increased chance of miscarriage 
Stillbirth 
Anaemia 
PET

Reduced IQ and neurodevelopment delay

Optimise T4 preconception
Antithyroid drugs
Radioactive iodine

T4 and TSH in each trimester - look at thyroid physiology in ENDO

Question 6

Postpartum thyroiditis:

How does it usually happen?

How long after birth does it usually happen?

Rx for hyperthyroidism?

Rx for hypothyroidism?

Answer 6

Hyperthyroidism followed by hypothyroidism

Usually, 4 months after

Self-limiting or beta-blockers

Drug ineffective as due to thyroid destruction which releases thyroxine.