Thyroid Disease In Pregnancy

Question 1

What is the recommended target for TSH in treatment of hypothyroidism in pregnancy?

Answer 1

< or = 2.5

Question 2

When do you treat sub clinical hypothyroidism in pregnancy?

Answer 2

IF TSH > or = 4:

• Definitely treat if > 10
• Definitely treat if + TPO Ab
• Consider Tx if 4-10 & - TPO Ab

If TSH 2.6-3.9:

• Definitely treat if + TPO Ab
• DO NOT treat if - TPO Ab

Question 3

Which antibody in Grave’s Disease is associated with fetal Graves?

Answer 3

TSH-R Ab

If high in the second trimester (3x ULN), then need fetal monitoring for Graves

Question 4

What is gestational transient thyrotoxicosis?

Answer 4

In normal pregnancy, thyroid binding globulin and total T4 increase by 7 weeks gestation and peak at 15 weeks.

hCG stimulates the TSH receptor on the thyroid gland causing increased thyroid hormone and decreased TSH.

Question 5

What features help you differentiate gestational thyrotoxicosis from Graves Orbitopathy?

Answer 5

Opathalmopathy, thyroid bruit, goitre and thyroid receptor antibody positivity make it more likely that a patient had Graves.