Thyroid disease in Pregnancy Flashcards
how do anovulatory cycles caused by hyper- and hypothyroidism effect pregnancy
reduce fertility
what thyroid hormone is important for neonatal development
maternal thyroxine(especially important for CNS development)
how does pregnancy affect the demand of the thyroid gland
increased demand
what effect does increased demand have on the thyroid gland and hormone production
increase size of gland, and increased production of T4 to maintain normal levels
what happens to patients with pre-existing hypothyroidism in pregnancy
unable to compensate for increased demand, leads to relative thyroid deficiency
what management is used for patients with pre-existing hypothyroidism
increase thyroxine by 25mcg soon as pregnancy suspected, average dose increases 50%over pregnancy(ie 100 to 150mcg), check TFTs, aim for TSH < 3mU/l
what are the risks of untreated hypothyroidism in pregnancy
increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour, decreased foetal neuropsychological development
what abnormal thyroid function tests are seen as a result of the hCG effect(increased hCG) in pregnancy
free T4 increase(14%), low TSH of 0.1-0.4(9%), hyperemesis gravidarum
what other disease does excess hCG mimic biochemically
hyperthyroidism
what is another name for excess hCG in pregnancy
gestational hCG-associated thyrotoxicosis
how can you distinguish between gestational hCG-associated thyrotoxicosis and hyperthyroidism
in gestational; hyperemesis, not TRab antibody positive, resolves by 20 weeks gestation
when would gestational hCG-associated thyrotoxicosis be treated
if persists longer than 20 weeks
what complications can arise from hyperthyroidism in pregnancy
infertility/ammenorheoa, spontaneous miscarriage, stillbirth, thyroid crisis in labour, transient neonatal thyrotoxicosis
what are some causes of thyrotoxicosis in pregnancy
Graves’ disease, toxic multinodular goitre, thyroid adenoma, thyroiditis
what non-pharmacological management is used for pregnancy in hyperthyroidism
wait and see; if hyperemesis will settle, Graves’ may settle as pregnancy suppresses autoimmunity, check TRAb antibodies
