Thyroid Function During Pregnancy: Clinical Manifestations and Complications

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Changes in thyroid function during pregnancy can lead to clinical manifestations like nervousness, tachycardia, and weight loss. Complications such as abortions, preterm delivery, and thyroid storm can occur. Treatment involves maintaining FT4 levels within the high normal range with medications like propylthiouracil and methimazole. Radioactive iodine is contraindicated during pregnancy, and thyroidectomy may be necessary for women intolerant to drugs.

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Uploaded on Feb 14, 2025 | 0 Views

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DR SALWA NEYAZI ASSISTANT PROF./CONSULTANT OBGYN PEDIATRIC & ADOLESCENT GYNECOLOGIST

Changes in thyroid function during preg Clinical manifestation, complications and treatment of hyper and hypothyroidism Postpartum thyroiditis

Increase TBG (estrogen effect) HCG acts like TSH 10-120% of preg women will have subclinical hyperthyroididsm and 60% of women with hydatiform mole or chorioca Stimulation of TSH receptors Hyperemesis gravidarum may be associated with subclinical or mild hyper thyroidism TSH---N FT4---N TT4---INCREASED TT3---INCREASED

CLINICAL MANIFESTATIONS Nervousness Tachycardia Palpitation Wt loss Tremors Flushing Frequent bowel movement Excessive swetting Insomnia Graves disease---goiter, exophthalmos,peritibialmyxedema

Graves disease 90% Toxic nodular goiter Iatrogenic Iodine induced Subacute thyroiditis HCG mediated

Abortions and stillbirth PET Preterm delivery Low birth weight Placental abruption Cardiac arrhythmias Congestive heart failure Thyroid storm Hyperemesis gravidarum

Low TSH Elevated FT4

Aim: to maintain FT4 level at the high normal range using the lowest drug dose Radioactive Iodine is absolutely contraindicated in pregnancy Propylthyouracil 50 mg bid or less is recommended for the Rx If it fails consider methimazole Beta blockers given to control the symptoms Thyoidectomy may be required during preg for women who can not tolerate drugs or have allergy or agranulocytosis

TSH does not cross the placenta TSH (receptor stimulating) antibodies ---can cross the placenta ---resulting in hyperthyroidism of the fetus in 1-5% Manifestations of hyperthyroidism in the fetus: - tachycardia -goiter -advanced bone age -IUGR -cardiac failure /hydrops

CLINICAL MANIFESTATIONS: Fatigu Constipation Intolerance to cold Dry skin Muscle cramps Hair loss Wt gain Myxedema Carpal tunnel S. Prolonged relaxation of deep tendon refelxes

Hashimoto disease Iodine defficiency Subacute thyroiditis Thyoidectomy Radioactive Iodine Rx

Abortions PET Preterm delivery IUGR Placental abruption PPH

Levo-thyroxin TSH should be checked and level adjusted

Congenital cretinism 1:4000 ---IUGR, MR, floppy baby, macroglossia, neuropsychological deficit Mental retardation IUGR Screening for hypothyroidism should be done for all neonates

It occurs in 5-10% of women in the first year after child birth There is increasing serum levels of autoantibodies Phase 1 thyrotoxicosis 1-4 months after delivery may return to euthyroid state or Phase 2 transient or permanent hypothyroidism 4-8 months post delivery Diagnosis ---abnormal TFT -antimicrosomal antibodies or -ATP (antithyroid peroxidase ) antibodiess