Thyroid Disease in Pregnancy
Thyroid Disease in Pregnancy
Thyroid Disease in Pregnancy
DISEASE IN
PREGNANCY
THYROID DISEASE IN
PREGNANCY
Second most common endocrine disorder
Increased risk of miscarriage, placental abruption, hypertensive disorders,
First trimester:
TSH decreases in early pregnancy because of weak stimulation of TSH receptors
Levels of TSH
First Trimester: 0.12.5 mIU/L
Second Trimester: 0.2-3.0 mIU/L
Third Trimester: 0.3-3.0 mIU/L
SCREENING
personal hx of thyroid disease or sx of
thyroid disease,
autoimmune disease,
previous delivery of infant with thyroid
disease,
type 1 DM,
high dose neck radiation,
recurrent fetal loss
recommended.
HYPERTHRYODIS
M
HYPERTHYROIDISM
Occurs in 2% of pregnancy; Graves disease accounts of 95% of the cases.
Other causes: gestational trophoblastic disease, nodular goiter or solitary
toxic adenoma, viral thyroiditis, and tumors of the pituitary gland or ovary
radioactive iodine are at high risk of neonatal Graves disease because they
lack suppresive thioamide. (Less incidence in patient on thioamide
treatment)
SUBCLINICAL
HYPERTHYRODISM
1.7% of pregnant woman
Abnormally low TSH with normal T4
Not associated with adverse outcomes
Treatment is not recommended (antithyroid medications crosses placenta)
HYPOTHYROIDIS
M
HYPOTHYROIDISM
Overt hypothyroidism: 0.2-1% of pregnancy
Increased TSH with decreased T4
Sx: fatigue, constipation, cold intolerance, muscle cramps, and weight gain.
Clinically: edema, dry skin, hair loss, and a prolonged relaxation phase of
SUBCLINICAL
HYPOTHYROIDISM
Elevated serum TSH level in the presence of a normal free T4 level
2-5 %
unlikely to progress to overt hypothyroidism during pregnancy in otherwise
healthy women.
INVESTIGATIONS
RECOMMENDATIONS
TSH and T4
Levels of TSH
First Trimester: 0.12.5 mIU/L
Second Trimester: 0.2-3.0 mIU/L
Third Trimester: 0.3-3.0 mIU/L
FT4)
TREATMENT :
HYPERTHYROIDISM
Goal: lowest possible thionamides to maintain FT4 above or in high normal range,
(regardless TSH) Measure FT4 2-4 weekly.
second trimester
TREATMENT:
HYPOTHYROIDISM
FT4 replacement: Levothyroxine 1-2mcg/kg daily or 100mcg OD
Post thyroidectomy/radioiodine therapy may require higher dosage
production)
concentrations of hCG.
rarely symptomatic, treatment with thionamide is not recommended
May be a/w multiple gestation or molar pregnancy
Advised for expectant management
Routine measurements of thyroid function are not recommended in
unit
THYROID NODULE/THYROID
CANCER IN PREGNANCY
Complete Hx and Physical examination, serum TSH, USG Neck
USG neck reliably detects nodules 0.5cm
USG features: Hypoechoic pattern, irregular margins, microcalcifications
FNAC, histologic tumor markers, imunostaining
POSTPARTUM THYROIDITIS
Defined as thyroid dysfunction within 12 mths of delivery
Evidence of hyperthyroidism (fatigue, irritability, weight loss, palpitations, or heat
REFERENCE
Thyroid Disease in Pregnancy. Practice Bulletin Number 148, Vol 125, No. 4,
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