thyrotoxicosis in pregnancy
TRANSCRIPT
TYROTOXICOSIS IN PREGNANCY
Dr Jamali WagimanObstetrician & Gynecologist
Hospital Kuala Lumpur
OVERVIEW
• 2: 1000 Pregnancies• Majority present pre
pregnancy• 0.5:1000 required
treatment.• Severe Thyrotoxicosis
is rare due to underlying unovulatory cycle.
PHYSIOLOGY
• Production of T4 • T3 (70-80%
peripheral conversion)
• TSH and TRH Controlled
• Functions– Energy Production– Protein Synthesis– Growth in Children
T4/T3 SYNTHESISDietary Iodide
OxidizedIodination
Combination
Thyroglobulin(Colloid)
20X
100-200 µg
MIT
DIT
MIT+ DIT = T3
MIT +MIT = T4
T4/T3 SECRETION
Thyroglobulin(Colloid)
T4:T3 (5:1)
TBG
0.05% T4
0.5% T3
HORMONAL CONTROL
• Hypothalamus • Pituitary• Thyroid Gland
TRH
TSH
T3/T4
TREATMENT
Carbimazole
Propylthiourasil
Beta Blocker
Surgery
Radioiodine Therapy.
Synthesis
T4T3
PeripheralConversionMetabolic Effect
FOLLOW UP
7 days1.5 days
T3
T4
Monthly Monitoring of FT4/TSH
Review Symptom
Compliance to Treatment
Initial treatment and remissionStable treatmentStopping TreatmentClinical relapse
EFFECT TO PREGNANCY
• 48% Fetal mortality• 21% Chance of
Thyroid Crisis at Delivery– Confusion– Psychotic– Coma– Tachycardia– Cardiac Arrythmias– Cardiac Failure (5-8%)– Fever
PTUIV IodideDexamethasoneIV PropanololDigoxineDiuretic
Thyroid Storm
GRAVE DISEASE
• 95% Thyrotoxicosis in Pregnancy
• Poor weight gain• Symptomatic
– Exophthalmos– Lid Lag– Palpitation
Autoantibody
T4:T3
Absent of Feedback MechanismAbsent of Feedback Mechanism
GRAVES DISEASE
T3 T4
Y
Y
Y YY
THYROID FUNCTION TEST