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4-Thyroid diseases > Thyroid Dysfunction And Reproductive Health > Flashcards

Thyroid Dysfunction And Reproductive Health Flashcards

1
Q

What is the most common endocrine condition affecting women of reproductive age?

A

Thyroid dysfunction

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2
Q

What is recommended about thyroid measurements in subfertile women?

A

No routine measurements in asymptomatic patients

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3
Q

What is the rate of hyperthyroidism in subfertile women compared with general population?

A

2.3 % compared with 1.5 % in general population

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4
Q

What menstrual irregularity associated with hyperthyroidism?

A

Hypomenorrhoea
Polymenorrhoea
+ sensitivity to Gnrh 》+ Lh 》 + SHBG 》 + total estrogens

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5
Q

What is the rate of anovulatation in women with hyperthyroidism ?

A

Most women remain ovulatory.
And there is no evidence that treatment of either subclinical or clinical hyperthyroidism improves the rate of ovulation

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6
Q

What is the impact of radioactive iodine on fertility?

A

No deterioration in gonadal function
Or adverse outcomes in offspring

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7
Q

What is the period of time the pregnancy is delayed after treatment with radioactive iodine?

A

6 months

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8
Q

What drug causes hypothyroidism?

A

Amiodaron / lithium

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9
Q

What is the prevalence of hypothyroidism and subclinical hypothyroidism in women in reproductive age?

A

0.5 %
Subclinical: 2 - 4 %

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10
Q

How does hypothyroidism affect fertility?

A

It affects the pulsatile release of GnRH which is required for cyclical release of fsh Lh

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11
Q

What TSH level is required in women undergoing ART?

A

< 2.5 mu/ml

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12
Q

The impact of treatment with levothyroxine( in women with overt or subclinical hypothyroidism) on implantation and pregnancy and live birth rates?

A

Improves the rates . But still reduced compared with euthyroid

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13
Q

Recommendations about TSH levels in sub fertility setting ?

A

Keep tsh below 2.5 mu/ml per conception in line with guidelines for first trimester tsh levels

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14
Q

What is the most common cause for hypothyroidism in women of reproductive age?

A

Autoimmune thyroid disease
AITD

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15
Q

Thyroid autoantibodies are present in what rate in :
Hashimoto’s thyroiditis
Postpartum thyroiditis
Graves disease

A

All
2/3
3/4
Respectively

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16
Q

What is the prevalence of thyroid autoimmunity among general population?

A

Up to 25%
And higher in those with endometriosis and pco
And subfertile group

17
Q

Management of thyroid diseases in the fertility setting if Tsh 2.5 - 4.5 ?

A

1 - repeat Tsh
2- test thyroid autoantibodies
If tsh still > 2.5 commence thyroxin.
And test tsh every 6 weeks until < 2.5
If +ve antibodies in case of pregnancy results : monitor TFT
Fetal growth

18
Q

Management of thyroid diseases in fertility setting if TSH > 4.5 ?

A

1- commence levothyroxine
2- check T3 T4 autoantibodies

19
Q

What are the physiological changes of pregnancy in thyroid functions ?

A
  • 1- increased thyroid binding globulin due to estrogen stimulation
    2- increased clearance if free thyroid hormones due to increased glomerular filtration
    Result in : reduction in free thyroid hormones
  • bhcg is closely related structurally to Tsh which stimulates thyroid hormones release and suppresses Tsh in first trimester
  • in 2nd and 3d trimester Bhcg levels fall accompanied by rise in tsh
20
Q

What is the miscarriage rate in women euthyroid and positive for thyroid autoantibodies ?

A

Three fold increase

21
Q

What is the most common cause for hyperthyroidism in pregnancy?

A

Graves disease affecting 1 % of pregnancies

22
Q

What is the cause of gestational hypothyroidism? Prevalence?

A

Stimulation of Tsh receptors by B hcg
Affecting 1-3% of pregnancies

23
Q

How to distinguish between graves disease and gestational hyperthyroidism?

A

TSH stimulating receptors antibodies is diagnostic of graves disease TSI

24
Q

Management of gestational hyperthyroidism?

A

Supportive management
(Free T4 tends to return to normal in 2nd trimester )
Thyroid replacement is not required

25
Q

Management of Graves disease in pregnancy?

A

Propylthiouracil is preferred
( because of lower levels of teratogenicity
Carbimazol : in 2nd trimester
( concerns over propylthiouracil hepatotoxicity in offspring)

26
Q

What are the risks of Graves disease in pregnancy?

A

Preterm birth
Pre eclampsia
FGR
Heart failure
Still birth

27
Q

What is the particular risk in the infants of hypothyroidism mothers?

A

Neurodevelopmental delay
(Because of the fetal requirements for maternal T4 until 12 weeks of gestation ) after that T3 T4 Tsh don’t cross the placenta

28
Q

What are the neonatal complications of hypothyroidism in pregnancy?

A

1- neurodevelopmental delay
2- neonatal hypothyroidism ( trans placental transfer of Tsh receptors blocking antibodies)(mainly seen in atrophic thyroiditis)
3- prematurity/ low birth weight
4- fetal distress in labour
5- stillbirth
6- perinatal death
7- congenial malformations

29
Q

What are the maternal complications of hypothyroidism in pregnancy?

A

1- anaemia
2- postpartum hemorrhage
3- cardiac failure
4- pre eclampsia
5- placental abruption

30
Q

What is the major risk in women euthyroid with AITD in pregnancy?

A

Preterm birth
2 to 4 folds Increased risk
(Eventhough treatment with thyroxin is not recommended )

31
Q

What are the risk factors of thyroid dysfunction which indicates screening ?

A

1 History of thyroid dysfunction/surgery
2 Family history of thyroid dysfunction
3 Goitre
4 Clinical signs of hypothyroidism
5 + ve thyroid autoantibodies
6 Diabetes type 1
7 Other autoimmune disorders
8 History of miscarriage/preterm
9 History of subfertility
10 Age > 30
11 History of head/ neck irradiation
12 Previous treatment of amiodaron/lithium
13Recent exposure to iodine radiological agents

32
Q

How to adjust L T4 dose in pregnancy?

A

Initially 25 mcg / daily
Tsh every 4- 6 weeks
Further increase may required to maintain the Tsh 0.5- 2.5

33
Q

Trimester specific Tsh ranges ?

A

1st : 0.1 - 2.5
2nd : 0.2 - 3
3d: 0.3 - 3

34
Q

How often Tsh would be tested in women euthyroid with AITD In pregnancy?

A

Every 4 weeks in early pregnancy
And at least once between 26-32 weeks

35
Q

When to check Tsh postpartum in hypothyroidism women?

A

6-8 weeks postpartum

36
Q

Is there any recommendations about euthyroid + AITD and treatment with LT4?

A

No recommendations of treatment both preconception or during pregnancy

4-Thyroid diseases (5 decks)

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