Thyroid Pregnancy/Emergencies

Question 1

t/f hcg inhibits thyrocytes and causes decrease in ft4

Answer 1

false, it stimulates thyrocytes and increases ft4

Question 2

gestational hyperthyroidism is associated with ___

Answer 2

hyperemesis gravidarum

Question 3

____ causes serum thyroid hormones to rise up to 1.5x in the first trimester

Answer 3

estrogen

Question 4

t/f there is increased thyroid hormone metabolism by the placenta

Answer 4

true

Question 5

t/f maternal intake of iodine must be increased in the first and third trimesters

Answer 5

false, second and third trimesters

Question 6

thyroid function in first trimester

Answer 6

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)

Question 7

thyroid function in second trimester

Answer 7

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)

Question 8

thyroid function in third trimester

Answer 8

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)

Question 9

t/f universal screening for thyroid function in pregnant women is not yet recommended

Answer 9

true, advocate targeted tsh testing

Question 10

risk factors for thyroid diseases in preg

Answer 10

family history
autoimmune diorders
infertility
prior preterm delivery/recurrent miscarriage
signs or symptoms of thyroid disease
>30 yo

Question 11

target tsh of pregnant

Answer 11

prepregnancy: <2.5 mlU/l
first tri: < 2.5 mlU/l
second/third tri: 3.0 mlU/L

Question 12

when to do thyroid fn testing in pregnant

Answer 12

upon pregnancy confirmation
every 4 weeks in first 6 mos
every 6-8 weeks after 20 wks aog

Question 13

management of hypothy

Answer 13

increase levothyroxine by up to 45%

return back to old dose after delivery

Question 14

management of gd in pregnancy

Answer 14

1st tri (16 wks aog): ptu, methimazole contraindicated
2nd tri: methimazole, ptu is more hepatotoxic

Question 15

target t4/ft4 in gd in preg

Answer 15

at or just above pregnancy reference range

Question 16

who can discontinue atds in pregnancy

Answer 16

clinically and biochemically euthyroid

on low dose methimazole/ptu

Question 17

end stage of untreated hypothyroidism

Answer 17

myxedema coma

Question 18

clincal manifestations of myxedema coma

Answer 18

hypothermia (< 24 C)
severe myxedema, bradycardia, hypotension
reduced sensorium
seizures during comatose

Question 19

thyroid hormone strat for myxedema coma

Answer 19

• 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

Question 20

supportive therapy for myxedema coma

Answer 20

internal/external warming
hydrocortisone
antibiotics
ventilatory support for first 48 hrs of admission!! 
hypertonic saline
iv glucose

Question 21

what is thyroid storm

Answer 21

accelerated hyperthyroidism or thyrotoxic crisis

Question 22

clinical features of thyroid storm

Answer 22

severe hypermetabolism!
invariable high grade fever!
significantly altered mental status!

vomiting, diarrhea, jaundice

Question 23

t/f you can delay treatment for thyroid storm

Answer 23

FALSE, IT’S A MEDICAL EMERGENCY DO NOT WAIT FOR LABS TO COME BACK BEFORE INTERVENTION

Question 24

components of burch and wartofsky scoring

Answer 24

> /= 25 = thyroid storm

temp
cns effects
gi dysfunction
cv dysfunction
hf
precipitant history

Question 25

drugs used for thyroid storm

Answer 25

• ptu blocks t4 to t3 conversion
• methimazole blocks new hormone synthesis
• propanolol
• iodine blocks new hormone synthesis and release
• hydrocortisone or dexamethasone as prophylaxis against adrenal insufficiency

Question 26

first step in thyroid storm management

Answer 26

give large dose of antithyroid drug

ptu > methimazole

Question 27

second step in thyroid storm management

Answer 27

iodine (saturated solution of potassium iodide or lugol’s soln) 1 hour after antithyroid drug

Question 28

third step in thyroid storm management

Answer 28

propanolol or esmolol for beta adrenergic blockade

Question 29

fourth step in thyroid storm management

Answer 29

steroids to support response to stress and inhibit hormone release within 24-48 hrs

Question 30

treatment outcomes in thyroid storm

Answer 30

successful: improvement in 1-2 days, recovery in 1 week