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p Thyroiddisease is a disorder that results
when the thyroid gland produces more or less
thyroid hormone than the body needs

p Divided into two:


-hyperthyroidism
-hypothyroidism
p Twopregnancy-related hormones³(hCG)
and estrogen³cause increased thyroid
hormone levels in the blood.

p Madeby the placenta, hCG is similar to


TSH and mildly stimulates the thyroid to
produce more thyroid hormone.
p ‘ncreasedestrogen produces higher levels
of thyroid-binding globulin, a protein that
transports thyroid hormone in the blood.

p Thesenormal hormonal changes can


sometimes make thyroid function tests
during pregnancy difficult to interpret.
p =st trimester, the fetus depends on the mother·s
supply of thyroid hormone, which it gets through
the placenta.

p At = to = weeks, the baby·s thyroid begins to


function on its own.

p The baby gets its supply of iodine, which the


thyroid gland uses to make thyroid hormone,
through the mother·s diet.
p [omen need more iodine when they are
pregnant³about  micrograms (—g) a
day

p thyroid gland enlarges slightly in healthy


women during pregnancy- X enough to be
detected by PE.

p Higher levels of thyroid hormone in the


blood, increased thyroid size, and other
symptoms common to both pregnancy and
thyroid disorders³such as fatigue³can
make thyroid problems hard to diagnose in
pregnancy.
p usuallycaused by Graves· disease and
occurs in =: pregnancies

p inGraves· disease, the immune system


makes an antibody called thyroid
stimulating immunoglobulin which mimics
TSH and causes the thyroid to make too
much thyroid hormone.
pa woman with
preexisting Graves·
disease usually improves
in nd and 3rd trimester.

p itusually worsens again


in the first few months
after delivery
p Graves disease
p Toxic multinodular goitre
p Toxic adenoma
p Carcinoma
p Subacute thyroiditis
p Amiodarone
p Lithium
p Trophoblastic ds
p Hyperemesis gravidarum
p §ncontrolled hyperthyroidism during
pregnancy can lead to
-congestive heart failure
-preeclampsia³a dangerous rise in blood
pressure in late pregnancy
-thyroid storm³a sudden, severe worsening
of symptoms
-Cardiac arrhytmias including atrial
fibrillation
-Diarrhoea
-Vomiting
-Abdominal pain
-Psychosis
p Due to autoimmune ds:
- thyroid stimulating ab may cross the
placenta and cause fetal thyrotoxicosis and
goitre
p Main complications for baby:
-fetal growth restriction
-stillbirth
-fetal tachycardia
-premature delivery
-miscarriage
-low birthweight
-increased perinatal mortality
p Some symptoms are common features in early
pregnancies, including mild maternal tachycardia,
heat intolerance, fatigue, weight loss and heart
murmur

p Other more indicative symptoms: rapid and irregular


heartbeat, a fine tremor, unexplained weight loss or
failure to have normal pregnancy weight gain, and
the severe nausea and vomiting

p Confirmed by high level of FT4 and FT3, with


reduced level of TSH
p Mild hyperthyroidism in which TSH is low but free T4 is
normal does not require treatment

p Propylthiouracil (PT§) or sometimes methimazole- use


lowest dose as it cross placenta

p Beta-blockers may be indicated initially before


antithyroid drugs take effects

p Radioactive iodines-contraindicated because it


completely obliterates fetal thyroid gland

p Rarely, surgical used (dysphagia,stridor,suspected ca,


allergies to drug)
p Causes:
-iodine deficiency
- Hashimoto·s thyroiditis
-atrophic thyroiditis
- congenital absence of thyroid
- inadequately treated existing hypothyroidism
- treated hyperthyroidism : surgery, radioiodine or
drugs( amiodarone,lithium,iodine,antithyroid drugs)
p Some of the same problems caused by hyperthyroidism
can occur in hypothyroidism. §ncontrolled
hypothyroidism during pregnancy can lead to
-congestive heart failure
-pre-eclampsia
-anemia
-miscarriage
-low birthweight
-stillbirth
-cognitive and developmental disabilities in the baby
p High levels of TSH and low levels of free T4

pSymptoms of hypothyroidism in pregnancy include


-extreme fatigue
-cold intolerance
-muscle cramps
-constipation
-problems with memory or concentration.
p synthetic thyroxine-identical to the T4 made by the
thyroid gland
p [omen with pre-existing hypothyroidism will need to
increase their prepregnancy dose of thyroxine
p Thyroid function should be checked every 6 to 8
weeks during pregnancy
p ‘f the dx is made in px, in the absence of cardiac ds,
consider a starting dose of = —g daily.
p ‘n practice, aim for a TSH level <.mu/l
p Thyroxine can be safely taken during breast-feeding.
p inflammation of the thyroid gland that appears = to 8
months after giving birth

p ‘s an autoimmune condition and causes mild


hyperthyroidism that usually lasts = to  months

p develop hypothyroidism lasting 6 to = months before


the thyroid regains normal function

p ‘n some women, the thyroid is too damaged to regain


normal function and their hypothyroidism is
permanent- require lifelong treatment with synthetic
thyroid hormone
p Based on symptoms and not biochemical results

p Most recover spontaneously

p Hyperthyroid phase: Beta-blockers

p Hypothyroid phase: thyroxine ² treatment should


be withdrawn after 6 months to check for
recovery

p Long term follow up should be with annual TFT


p Common, affect  of women in their reproductive years

p Symptoms@ signs suggestive of malignancy


-past hx of radiation to neck or chest
-fixed lump
-lymphadenopathy
-rapid growth of painless nodule
-rapid growth of painless nodules
-voice change
-neurological involvement eg: Horner·s syndrome
p Differential
dx- solitary toxic nodule,
subacute thyroiditis,a bleed into a cystic
lesion

p ‘nvestigations:
-TFT and thyroid ab
-thyroglobulin level: malignant if >= —g/l
-§SS: cystic nodules > benign than solid
nodules
-fine needle aspiration 4 cytology
(cystic lesion)
-biopsy (solid lesion)
p Malignant lesions can
be surgically treated
in nd and 3rd
trimester, and
postoperatively
thyroxine can be
safely given to
completely suppress
TSH in TSH-dependent
tumours.