Thyrotoxicosis / Pregnancy / Oxford

Question 1

What is the most common cause of thyrotoxicosis in pregnancy?

Answer 1

Graves disease 95 %

Question 2

What is the prevalence of thyrotoxicosis in pregnancy?

Answer 2

1 / 5000

Question 3

What are the features of thyrotoxicosis in pregnancy?

Answer 3

Weight loss
Tremors
Persistent tachycardia
Eye signs

Question 4

What is the effect of pregnancy on thyrotoxicosis?

Answer 4

Improves in 2nd / 3d trimester
Deteriorates in the puerperium
( because pregnancy is a state of immunodeficiency)

Question 5

What is the effect of thyrotoxicosis on pregnancy?

Answer 5

Subfertility
Miscarriage
IUGR
Premature delivery
Thyroid storm

Question 6

Fetal thyrotoxicosis occurence in women with Graves disease?

Answer 6

10 % of the babies

Question 7

What are the features of thyroid storm?

Answer 7

1- pyrexia
2- confusion
3- cardiac failure

Question 8

What to monitor if antibodies are present in women with a history of Graves disease?

Answer 8

1- fetal heart rate
2- serial USS
3- fetal growth
4- fetal Goitre

Question 9

What is the half life of thyroid antibodies?

Answer 9

3 weeks……> neonatal hyperthyroidism may occur

Question 10

What is the aim of treatment in thyrotoxicosis?

Answer 10

To achieve euthyroid with T4 at the upper limit of normal.

Question 11

Name medications could be used in thyrotoxicosis?

Answer 11

PTU
Carbimazol
B blockers (to relieve symptoms in new cases for a short period of time)

Question 12

Which anti thyroid drugs is preferred in breastfeeding?

Answer 12

PTU - less transfer into milk
Dose < 150 mg / day
Carbimazol dose < 15 mg / day
TFT in baby should be monitored at higher doses

Question 13

What are the indications of thyroidectomy in pregnancy?

Answer 13

It’s safe
1- dysphagia
2- stridor 3- suspected carcinoma
4- allergy to both anti thyroid drugs

Question 14

What are the causes of thyrotoxicosis?

Answer 14

Graves disease 95%
Toxic multinodular goitre
Toxic thyroiditis
Carcinoma
Subacute thyroiditis
Amiodaron/ lithium

Question 15

What serious maternal side effect of thionamide ( carbimazol- ptu-..) require immediate discontinuation of therapy?

Answer 15

Granulocytosis
( fever- sore throat)

Question 16

What is the major potential fetal complication of thionamide therapy during pregnancy?

Answer 16

Hypothyroidism

Question 17

List potential maternal side effects of PTU that occur in the first few months of therapy?

Answer 17

1- fever
2- sore throat
__________________ stop medication
__________________( granulocytosis)
3- unusual bruising
4- bleeding - leukopenia
5- nausea/vomiting
6- abdominal pain
7- headache
8-hepatotoxicity- thrombocytopenia
9- skin rash
10 - arthritis

Question 18

What is the specific potential complication may occur in the offspring of a woman using methimazole during pregnancy?

Answer 18

**Aplasia cutis ( usually in the scalp)
* esophageal atresia

Question 19

In what situations B blockers are indicated in patients who are hyperthyroid?

Answer 19

Thyroid storm
For rapid control of symptoms

Question 20

What are the potential fetal or neonatal complications
of long term B blockers use?

Answer 20

IUGR
Neonatal bradycardia
Neonatal hypoglycemia

Question 21

What is the mechanism of action of
- PTU
- methemazole

Answer 21

PUT : inhibits conversion of T4 into T3
Dose 50- 150 mg
Methimazole: inhibits thyroid peroxidase… inhibits the synthesis of T4
Dose loading: 10- 20 mg
Maintenance: 5-10 mg

Question 22

What fetal complications might occur if maternal hyperthyroidism untreated?

Answer 22

1- increased perinatal mortality
2- fetal tachycardia/heart failure
3- hearing loss
4- hyper/ hypothyroid with/ without goitre
5- preterm labour
6- IUGR
**7- non immune HYDROPS