Thyroid Storm In Pregnancy

Question 0

Most common cause of thyrotoxicosis in US? Physical exam sign that is suggestive?

Most common cause of hyperthyroidism postpartum? Mechanism?

Answer 0

Graves Disease, diffusely enlarged goiter

Destructive lymphocytic thyroiditis; high corticosteroid levels and pregnancy suppress autoimmune antibodies, resulting in a flare postpartum

Question 1

Thyroid storm?

Answer 1

Thyrotoxicosis leading to

1. CNS dysfunction (coma/altered mental status)
2. Autonomic instability (hyperthermia, hypertension, hypertension)

Question 2

biologically active thyroxine hormone?

Answer 2

T3

Question 3

Treatment of hyperthyroidism during pregnancy?

Answer 3

PTU > methimazole > radioactive iodine

methimazole possibly associated with plasia cutis congenital – Skin/scalp defects

Question 4

Tx of thyroid storm?

Answer 4

1. PTU
2. Beta blockers to control tachycardia
3. Acetaminophen/cooling blankets for hyperthermia
4. Steroids to prevent conversion of T4 to T3

Question 5

Antenatal treatment of maternal hyperthyroidism in pregnancy can result in? Management?

Failure to treat may result in?

Answer 5

Fetal hyper- or hypothyroidism. Maternal administration PTU or Intra-amniotic injection of thyroxine for fetal hyper- and hypothyroidism respectively

Non-immune hydrops and fetal demise

Question 6

Effect of maternal subclinical hypothyroidism in children? Possible prevention?

Answer 6

Adverse neurological development/abnormal intelligence

Levothyroxine in the first trimester

Question 7

Effect of pregnancy on thyroid hormones? Changes due to?

Answer 7

Increase in thyroid-binding globulin and total T4

No Change in free T4 or TSH

Estrogen

Question 8

Antibodies seen in destructive lymphocytic thyroiditis?

Answer 8

Antimicrosomal and anti-peroxidase