Thyroid Pregnancy/Emergencies Flashcards
t/f hcg inhibits thyrocytes and causes decrease in ft4
false, it stimulates thyrocytes and increases ft4
gestational hyperthyroidism is associated with ___
hyperemesis gravidarum
____ causes serum thyroid hormones to rise up to 1.5x in the first trimester
estrogen
t/f there is increased thyroid hormone metabolism by the placenta
true
t/f maternal intake of iodine must be increased in the first and third trimesters
false, second and third trimesters
thyroid function in first trimester
tsh 0.3-3.8 ulU/ml (1.2)
ft4 11-24 pmol/l (15.2)
fts 2.2-6.8 pmol/l (3.7)
thyroid function in second trimester
tsh 0.3-3.8 ulU/ml (1.4)
ft4 11-24 pmol/l (13.0)
fts 2.2-6.8 pmol/l (3.7)
thyroid function in third trimester
tsh 0.3-3.8 ulU/ml (1.4)
ft4 11-24 pmol/l (13.40)
fts 2.2-6.8 pmol/l (2.9)
t/f universal screening for thyroid function in pregnant women is not yet recommended
true, advocate targeted tsh testing
risk factors for thyroid diseases in preg
family history autoimmune diorders infertility prior preterm delivery/recurrent miscarriage signs or symptoms of thyroid disease >30 yo
target tsh of pregnant
prepregnancy: <2.5 mlU/l
first tri: < 2.5 mlU/l
second/third tri: 3.0 mlU/L
when to do thyroid fn testing in pregnant
upon pregnancy confirmation
every 4 weeks in first 6 mos
every 6-8 weeks after 20 wks aog
management of hypothy
increase levothyroxine by up to 45%
return back to old dose after delivery
management of gd in pregnancy
1st tri (16 wks aog): ptu, methimazole contraindicated 2nd tri: methimazole, ptu is more hepatotoxic
target t4/ft4 in gd in preg
at or just above pregnancy reference range
who can discontinue atds in pregnancy
clinically and biochemically euthyroid
on low dose methimazole/ptu
end stage of untreated hypothyroidism
myxedema coma
clincal manifestations of myxedema coma
hypothermia (< 24 C)
severe myxedema, bradycardia, hypotension
reduced sensorium
seizures during comatose
thyroid hormone strat for myxedema coma
- IV preferred
- levothyroxine loading dose 200-400 mcg IV/NGT/rectal, replacement dose 1.6 mcg/kg PO
- liothyronine (T3) 10-25 mcg IV/NGT/rectal every 8-12 hrs
supportive therapy for myxedema coma
internal/external warming hydrocortisone antibiotics ventilatory support for first 48 hrs of admission!! hypertonic saline iv glucose
what is thyroid storm
accelerated hyperthyroidism or thyrotoxic crisis
clinical features of thyroid storm
severe hypermetabolism!
invariable high grade fever!
significantly altered mental status!
vomiting, diarrhea, jaundice
t/f you can delay treatment for thyroid storm
FALSE, IT’S A MEDICAL EMERGENCY DO NOT WAIT FOR LABS TO COME BACK BEFORE INTERVENTION
components of burch and wartofsky scoring
> /= 25 = thyroid storm
temp cns effects gi dysfunction cv dysfunction hf precipitant history
