Endocrine Disorders of Pregnancy

Question 1

What can use an increased serum “total” T4 and T3 levels

Answer 1

increase in serum T4 binding globulin production caused by elevated oestrogen levels

Question 2

Why do thyroid hormone requirements increase during pregnancy

Answer 2

Increased weight
placental deiodinase activity
transfer of T4 to the foetus

Question 3

Maternal TSH does not cross the placenta. True or false

Answer 3

True

Question 4

What thyroid hormones cross the placenta

Answer 4

T3 and T4

Question 5

At what stage of development does metal TSH appear

Answer 5

around the 10th week of gestation

Question 6

What are the thyroid hormones important for in development

Answer 6

Cognitive development during early pregnancy

Question 7

What is hypothyroidism in pregnancy associated with

Answer 7

early pregnancy loss 
placental abruption
pre-eclampsia 
preterm delivery 
low birth weight 
perinatal mortality 
neuropsychological impairment

Question 8

What is the ideal TSH level in hypothyroidism which has been diagnosed before pregnancy

Answer 8

TSH level of less than 2.5mU/L

Question 9

What are hypothyroid patients unable to do

Answer 9

increase their T4 and T3 secretion

Question 10

What should the dose of levothyroxine be increased by and when

Answer 10

30-50% by 4-6 weeks gestation

Question 11

What are further dose changes of levothyroxine based upon

Answer 11

serum TSH concentrations

Question 12

How often should serum TSH be measured

Answer 12

4-6 weeks after conception
4-6 weeks after any change in the dose
at least once each trimester

Question 13

What should happen to the dosage of levothyroxine after delivery

Answer 13

it should be reduced to pre-pregnancy levels

Question 14

What is poorly controlled hyperthyroidism in pregnancy associated with

Answer 14

Pregnancy loss 
premature labour 
low birth weight 
pre-eclampsia 
maternal cardiac failure

Question 15

Why is it difficult to diagnose hyperthyroidism during pregnancy

Answer 15

many of the symptoms are similar to the non-specific symptoms associated with pregnancy

Question 16

What is the diagnosis of hyperthyroidism in pregnant women made

Answer 16

based primarily on a serum TSH less than 0.01mU/L and a high serum free T4 and or free T3

Question 17

What is helpful in making the diagnosis of Graves’ disease during pregnancy

Answer 17

Measurement of TSH-receptor antibodies (TRAbs)

Question 18

What should Hyperthyroidism due to Graves’ disease or hyper functioning thyroid nodules be treated with

Answer 18

antithyroid drugs

Question 19

When might a subtotal thyroidectomy be indicated in hyperthyroid women during pregnancy

Answer 19

women who cannot tolerate antithyroid drugs because of allergy or agranulocytosis

Question 20

When is the optimal timing of surgery

Answer 20

second trimester

Question 21

Why do some neonates born to women with Graves’ disease have hyperthyroidism

Answer 21

due to the transplacental transfer of TSH receptor stimulating antibodies

Question 22

What is hyperemesis gravidarum characterised by

Answer 22

nausea
vomiting
weight loss
all during early pregnancy

Question 23

Describe the levels of T4 and T3 in hyperemesis gravidarum

Answer 23

Serum free T4 is minimally elevated and serum T3 is usually not elevated

Question 24

What is the treatment for hyperemesis gravidarum

Answer 24

Nothing - it resolves as hCG production falls
IV fluids
anti-emetics and nutritional support

Question 25

What can cause thyroid enlargement

Answer 25

iodine depletion (due to increased maternal renal clearance and metal uptake of iodine )

Question 26

What do women with malignant or suspicious cytology require

Answer 26

surgery

Question 27

What do prolactinomas usually result in

Answer 27

infertility due to the inhibitory effect of prolactin on gonadotrophin secretion

Question 28

What are patients with microprolactinomas treated with

Answer 28

dopamine agonist prior to pregnancy

Question 29

When is a dopamine agonist discontinued

Answer 29

as soon as pregnancy has been confirmed

Question 30

What should be given to a patient with a macroprolactinoma in order to shrink the tumour prior to pregnancy

Answer 30

Cromocriptine or cabergoline

Question 31

Why is breast feeding contraindicated in women who have neurological symptoms at the time of delivery

Answer 31

They should be treated with a dopamine agonist

Question 32

Describe the effect of Addison's disease in pregnancy

Answer 32

The foetus produces and regulates its own adrenal steroids | Therefore, pre-existing primary adrenal insufficiency in the mother is not associated with metal morbidity

Question 33

Describe the changes of treatment in a pregnant woman with Addison's to a non-pregnant woman

Answer 33

They are the same

Question 34

What should be given at the time of delivery in a patient with Addison's and why

Answer 34

high dose IM hydrocortisone to cover the stress

Question 35

How might Addison's disease that has developed in pregnancy present

Answer 35

adrenal crisis particularly at time of delivery

Question 36

What is the main sign of phaeochromocytoma

Answer 36

Hypertension paroxysmal headache sweating palpitation

Question 37

How is the diagnosis of phaeochromocytomas in pregnancy made

Answer 37

3 24 hour urine collections for the measurement of catecholamines and fractionated metanephrines MRI is use for localisation of tumours after confirmation of the diagnosis

Question 38

What is the treatment for a phaechoromocytoma in a pregnant woman

Answer 38

phenoben`amine (alpha blocker) 10mg BD and increased gradually

Question 39

What is gestational diabetes mellitus

Answer 39

glucose intolerance with an onset or first recognition during pregnancy

Question 40

What results in the maternal insulin resistance in gestational diabetes

Answer 40

Increased placental secretion of diabetogenic hormones such as growth hormone, corticotrophin-releasing hormone, human placental lactogen and progesterone

Question 41

Why does gestational diabetes occur in some women

Answer 41

pancreatic function cannot overcome both the insulin resistance created by these anti-insulin hormones and the increased fuel consumption necessary to provide for the growing mother and foetus

Question 42

How is gestational diabetes diagnosed

Answer 42

a 75mg 2 hour oral glucose tolerance test

Question 43

What else should be tested during routine prenatal testing during an assessment of women with diabetes

Answer 43

``` measurement of glycated haemoglobin urea creatinine and electrolytes TSH free T3 ECG ```

Question 44

What is meant by medical nutritional therapy

Answer 44

3 meals and 3 snacks a day | 40% carbs, 40% fat and 20% protein

Question 45

How often should patients check their blood glucose

Answer 45

upon awakening and 1 hour after each meal to evaluate the effectiveness of the medical nutritional therapy

Question 46

What is the goal of insulin therapy

Answer 46

a fasting blood glucose of less than 5mmol/L

Question 47

What is poorly controlled diabetes in the first trimester associated with

Answer 47

Miscarriage and congenital malformations

Question 48

When might earlier delivery be warranted

Answer 48

in the presence of high risk factors such as worsening retinopathy or nephropathy poor control pre-eclampsia or restricted metal growth

Question 49

What are women with gestational diabetes at an increased risk of developing

Answer 49

diabetes after pregnancy

Question 50

What might worsen in diabetics during pregnancy

Answer 50

diabetic retinopathy

Question 51

How often should diabetic patients be screened for diabetic retinopathy in pregnancy

Answer 51

during the first trimester and then every 3 months

Question 52

What can be carried out safely during pregnancy if required in diabetic retinopathy

Answer 52

Laser therapy and virtuous surgery