endocrinology and hematology of pregnancy

Question 1

in people with hypothyroidism, increase the dose of T4 when become pregnant why

Answer 1

during pregnancy, estrogen induces TBG production. Also HCG increases T4 production. If hypothyroidism, unable to increase the production –> risk for worsening hyothyroidism

Question 2

pregnancy with hypothyro - T3 or T4

Answer 2

only T4

Question 3

OCP mediated hypertension - treatment

Answer 3

stop OCPs and use an alternative method for contraception

Question 4

SERM - SE

Answer 4

1. hot flashes
2. Venous thromboembolism
3. ENdometrial hyperplasia + ca (only tamoxifen)

Question 5

low estrogen due to hypothalamus –> osteoporosis - treatment

Answer 5

estrogen repletion can offset bone loss, increasing caloric intake and/or decreasing exercise is a more effective means of increasing bone density

Question 6

Maternal thyroid testing in 1st trimester

Answer 6

increased total T4 and mildly increased fT4: due to HcG and estrogen (stimulates TBG)
Low TSH

Question 7

estrogen on TBG

Answer 7

increase production and decreased clearance

Question 8

fetal HR in fetal anemia

Answer 8

sinusoidal HR

Question 9

causes of hypothalamic amenorrhea

Answer 9

1. excessive physical training
2. very low calorie diet/starvation
3. weight loss
4. chronic illness
5. stress depression
6. anorexia nervosa

Question 10

functional hypotalamic amenorrhea -vasomotor symptoms?

Answer 10

no

Question 11

treatment of immature hypothalamic axis of adolescences

Answer 11

progesterone

Question 12

levothyroxine - placental

Answer 12

it does not cross it

Question 13

Neonatal thyrotoxicosis - special clinical feature / diagnosis / treatment

Answer 13

• low birth weight or preterm birth
• maternal anti-TSH more than 500%
• treatment: self resolves within 3 months. METHIMAZOL + b blockers

Question 14

first manifestation of puberty

Answer 14

breast development followed by menarche 2-2/5 years later

Question 15

insulin resistance in pregnancy due to

Answer 15

increased levels of placental somatomammotropin

Question 16

ABO hemolytic disease - RF

Answer 16

infants with blood A or B born to a mother with blood type 0

Question 17

ABO hemolytic disease - clinical features

Answer 17

• jaundice within 24 h
• anemia
• increased reticulocyte count
• hyperobilirubinemia
• coombs positive

Question 18

ABO hemolytic disease - management

Answer 18

serial bilirubin levels, oral hydration + photoherapy

exchange transfusion for severe anemia / hyperbilirubinemia

Question 19

anemia of pregnancy is defined as

Answer 19

Hb under 11 in 1st and 3rd trimesters

under 10.5 in the 2nd

Question 20

euthyroid sick syndrome

Answer 20

low total and free T3 and normal T4/TSH