Date post: | 18-Jan-2018 |
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Hyperthyroidism During Pregnancy
• Overt hyperthyroidism
• Subclinical hyperthyroidism
The Most Common Cause of Hyperthyroidism
• Graves’ disease
• hCG mediated hyperthyroidism• Hyper emesis gravidaraum• Multiple pregnancies• Trophoblastic disease
Changes in thyroid physiology
• TBG excess results in high serum total T4
concentrations (not free T4)
• High serum hCG results in transient
subclinical or overt hyperthyroidism
Pregnancy complications
• Spontaneous abortion• Premature labor• Low birth weight• Stillbirth• Preeclampsia• Heat failure• Thyroid storm
Diagnosis
• TSH < 0.1 or undetectable • Free T4• Free T3• Total T4• Total T3• TRAb
Treatment
• Indication• Moderate to severe overt hyperthyroidism T4 or T3 > 1.5 times• Thionamids + Betablockers Hypoglycemia IUGR
• Plasmapheresis • Radioiodine First 2 weeks Spontaneous miscarriage2 to 12 weeks Birth defects12 to 14 weeks fetal thyroid ablation
Hypothyroidism During Pregnancy
• Overt hypothyroidism 0.3 - 0.5
• Subclinical hypothyroidism 2 – 2.5
Pregnancy Complications• Preeclampsia and gestational hypertention• Placental abruption• Nonreassuring fetal heart rate tracing• Preterm delivery, including very preterm delivery • Low birth weight• Increased rate of cesarean section• Perinatal morbidity and mortality• Neuropsychological and cognitive impairment• Postpartum hemorrhage
Diagnosis
• First trimester 0.1 < TSH < 2.5 • Second trimester 0.2 < TSH < 3 T4• Third trimester 0.3 < TSH < 3• TPO in subclinical
The Universal Screening of Asymptomatic Pregnant Women
for Thyroid Dysfunction
Yes Noor
• ATA and ACOG recommend targeted case :• From an area of known modarate to severe iodine
insufficiency• Have a family or personal history of thyroid
disease • Have thyroid peroxidase antibodies • Type 1 diabetes • History of preterm delivery or miscarriage• History of head or neck radiation • BMI ≥ 40• Infertility • Age > 30 years
Treatment
• Indication• Overt moderate to severe 1.6 mcg/kg• TSH < 10 1mcg/kg• Subclinical • Per existing hypothyroidism TSH < 1.2
Positive TPO Complications
• Preterm birth• Fetal loss• Perinatal mortality• Large-for-gestational-age infants• Subclinical hypothyroidism• Post partum thyroiditis
Does Positive TPO Need Treatment?