Dr.Zil-e-Haider Syed

Gynae & Obstetrics unit II

THYROID DISEASE IN PREGNANCY

Thyroid function in Normal pregnancy

Reletive iodine deficiency state increased renal loss transfer to fetusTSH alpha subunit mimicker range broader and higherTBG increased estrogen increased TBGT4 hcg spillover..increased levels in early gestation

Hyperemesis gravidarum and molar pregnancy increased hcg…..increased T4 n decreased TSH

TFTs during pregnancy

Hyperthroidism

Prevalance

o 0.2% of pregnant womeno 95% Grave’s disease

Diagnosis

osymptoms/signs……. Lid lag, lid retraction, weight loss, palmer erythema ,emotional liability ,tremors ,persistent tachycardia, vomiting ,goiter, heat intolerance

o TFTS elevated free T4 T3 levels and

depressed TSH

Maternal risks

Heart failureThyroid stormMiscarriagesGrowth restrictionPreterm labourPlacental abruptionPIH,preclampsiaInfectionIncreased risk of congenital anomalies

Fetal risks

o Fetal or neonatal thyrotoxicosis Intrapartum assessment persistent tachycardia Goiter on ultrasound Growth restriction Neonatal diagnostic features exophthalmoses hepatosplenomegly thrombocytopenia Goiter Growth restriction Heart failure(hydrops fetalis) Jaundice Poor feeding Poor weight gain irritability

Management

PREPREGNANCY Hypomenorhagia,

Oligomenorrhea

Patient having radioiodine

Counseling and reassurance

Prenatalo Euthyroid clinical state(T4 at upper limit of

normal)o TFTs monthlyo Choice of drug Thyonamides(Carbimazole Propylthouracil) Propanalol Iodine treatment Radioactive iodine

o Surgery

Labour and deliveryo Adequately treated woman…..no increased riskso Thyroid storm exaggerated features of hyperthyroidism Hyperpyrexia CCF Dysrythmias Altered mental statuso Treatment of thyroid storm 1.to decrease thyroid hormone production( thionamides

and iodine) 2.to decrease effect of circulating hormone(propyl

thyouracil) 3.to provide supportive therapy

(ivfluids,propanalol,hydrocortisone) 4.to treat underlying cause

Postnatalo Care of neonate

o Breast feeding

o Watch for maternal worsening of symptoms

THANKS