Thyroid Disorders And SLE In Pregnancy

Question 1

Hyperthyroidism in pregnancy

Answer 1

M/C/C graves disease, hcg mediated (like in molar preg)
DIAGNOSIS:- T3,T4 increase
TSH decrease (<0.1)
MANAGEMENT:- best medical if not responsive
Surgery (radioactive I2 is contraindicated)
Medical:- * propylthiouracil…IN 1ST TRIMESTER. Can cross placenta. If used for long time may cause hepatotoxicity.
* Methimazole in 2ND ND 3RD TRIMESTER, carbimazole.. can cross placenta more lead to aplasia cutis, choanal atresia, esophageal atresia.
COMPLICATION:-
* Transient leukopenia 10%
* Agranulocytosis…… Stop Tx. Switch on to surgery
* Fetal hypothyroidism, goitre.

Question 2

Thyroid storm in pregnancy

Answer 2

Rare
M.c.c graves disease
Pt = 40… Fever, tachycardia, altered mental status, nausea, vomiting, cardiac arrhythmia.

TRIGGERS:- stressful event in the form of surgery
Labor, complete mole… Beta hcg levels high…. Suction evacuation.

MANAGEMENT:- beta blockers: propanolol, metoprolol ….. Short term therapy.
Corticosteroids

Question 3

Hypothyroidism in pregnancy

Answer 3

Mcc is I2 deficiency in developing countries.
In developed countries its hashimotos thyroiditis
Symptoms: nausea, vomiting, wt gain, cold intolerance.

*Fetus is dependent on mother thyroxine …for brain development even though fetal thyroid gland produces thyroxine from 12 wks.
* If female with hypothyroidism on thyroxine…..
Increase dose of thyroxine by 20-30%

DIAGNOSIS:- TSH increase, T3, T4 decrease.
DOC:- levothyroxine 100mcg from 1st trimester.