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THYROID DYSFUNCTION AND PREGNANCY DR SALINI MANDAL B.G. ASST PROFESSOR DEPT OF OBG FMHMC
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THYROID DYSFUNCTION
AND PREGNANCY
DR SALINI MANDAL B.G.
ASST PROFESSOR
DEPT OF OBG
FMHMC
HYPERTHYROIDISM
OIs a set of disorders that involve
excess synthesis and secretion
of thyroid hormones by the
thyroid gland.
O Nervousness
O Anxiety
O Increased perspiration
O Heat intolerance
O Hyperactivity
O Palpitations
O Tachycardia
O Systolic hypertension
O Warm, moist skin
O Smooth skin
O Stare
O Tremor
O Weight loss
O Muscle weakness
INCIDENCE
O 2 per 1000 pregnancies
COMPLICATIONS
MATERNAL
FETAL / NEONATAL
MATERNAL
MISCARRIAGE
O PRETERM DELIVERY
O PREECLAMPSIA
O CONGESTIVE CARDIAC FAILURE
PLACENTA ABRUPTIO
OTHYROID STORM (fever, fast
n irregular heart beat,
vomiting, diarrhoea)
OINFECTION
FETAL
OIUGR
OPREMATURITY
OSTILLBIRTH
OHYPERTHYROIDISM
OHYPOTHYROIDISM
O INCREASED MORBIDITY AND
MORTALITY
PATHOGENESIS
OTHYROID STIMULATING
ANTIBODIES CROSSES THE
PLACENTA PRODUCES
NEONATAL THYROTOXICOSIS
WITH INCREASED NEONATAL
DEATH.
INVESTIGATIONS
OTSH supressed.
OT3 and T4 elevated
OThyroid stimulating
immunoglobulins.
ORadioactive iodine uptake and scans
should not be done during pregnancy.
O It will cross the placenta and damage
the fetal thyroid gland permanently.
Treatment…
OAntithyroid drug.
OCarbimazole is given orally with a
daily dose of 20 – 60 mg and
maintained at this dose until the
patient becomes euthyroid.
OLater progressively reduced the
dosage to 5 – 15 mg daily.
OPropylthiouracil is given at a daily
use of 300 – 450 mg and continued
till the patient becomes euthyroid,
later maintained to 50- 150 mg daily.
OSide effects:
OCarbimazole may be asso with aplasia
cutis of the neonate.
OBoth the drugs may cause fetal goitre
and hypothyroidism.
ODrugs are not contraindicated
during breast feeding provided the
dose is kept relatively low and close
monitoring of the neonatal thyroid
functions is carried out.
OCord blood should be taken for
clincial diagnosis
OThyroidectomy, when required to relief
the pressure symptoms can be done
safely in the second trimester with prior
biochemical control
Preconceptional counselling
O Adequate treatment should be instituted to
bring down the thyroid function profile to
normal.
O Radioactive iodine therapy should not be given
to patients wanting pregnancy within 1 yr
O If pregnancy occurs, termination should be
done
HYPOTHYROIDISMAND
PREGNANCY
Either…
O First time diagnosis in pregnancy
O Hypothyroid women who either discontinue
thyroid therapy or who need larger doses in
pregnancy.
O Hyperthyroid women on excessive amounts of
antithyroid drugs.
OPrimary related to thyroid
autoimmunity.
OMyxedema rare as it leads to
infertility.
OUntreated early pregnancy wastage
of conceptus, prematurity, deficient
intellectual development of the child.
O Complications like :- preeclampsia,
anemia.
O Treatment:- TSH should be repeated at
interval of 6 – 8 weeks as there is
increased demand of thyroid hormone in
the second half of pregnancy.
Hyperthyroidism
Arsenicum iodatum
O Hyperthyroid.
O Thyroid: Goitre. Indurated gland.
O General: Warm or even very hot yet often
sensitive to cold or drafts.
O Better: Open air.
O Worse: Becoming heated in bed.
O Marked emaciation despite eating
ravenously.
Natrum mur
O Great weakness and weariness.
O Oversensitive to all sorts of influences.
O Hyperthyroidism.
O Great liability to take cold
Baryta carbonica
O Hyperthyroid,
O Thyroid: Huge swelling of gland.
O General: Appetite increased with
emaciation.
O Emaciation with large, pot-belly.
Zincum iod
O Zincum iodatum is suited to hyperthyroid
constitutions.
O Goitre.
O Cold sweat in umbilical region.
Kalium iodatum
O Hyperthyroid. Goitre.
O Thyroid: Diffusely enlarged.
O Thyroid enlarged and very sensitive to
touch.
O General: Aggravated by heat.
Lachesis mutus
O Hyperthyroid. Thyroiditis.
O Thyroid: Left-sided goitre.
O Tightness in throat; difficult swallowing.
Iodum
O Hyperthyroid. Goitre.
O Thyroid: Painful, enlarged thyroid.
O Right-sided goitre.
O Constriction in thyroid region.
O General: Hot. Intolerant of heat or warm room.
O Better: Eating. Cold bathing. Violent exertion.
O Emaciation despite huge appetite.
OARANEA IXOBOLA
OASARUM EUROPAEUM
OCALC FLUOR
OMAGNESIUM FLUOR
OTHALIUM METALLICUM
OSPONGIA
OBARYTA IOD
OLYCOPUS
OELATERIUM
O Fucus vesiculosus
O Ferrum iod
O Cactus
O Belladonna
O Aurum met
O Apis
O Thyroidinum
Hypothyroidism
Kali carb
O With soft pulse, coldness, general
depression, and very characteristic
stitches, which may be felt in any part of
the body, or in connection with any
affection.
O Pain in small spot on left side
Hypothyroidism.
Argentum nitricum
O Hypothyroidism.
O General: Hot. Averse to warm rooms.
O Better: Cool or open air.
O Corticotropinum
O Alumina
O Conium
O Gelsemium
O Graphites
O Lycopodium
O Sepia
