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Hyperthyroidism During Pregnancy

This article explores the complexities of thyroid disorders during pregnancy, focusing on hyperthyroidism and hypothyroidism. It discusses the common causes, including Graves' disease and subclinical hyperthyroidism, as well as pregnancy complications associated with these conditions, such as spontaneous abortion and preterm delivery. The diagnosis and treatment options, including thionamides and beta blockers for hyperthyroidism, are also covered. Additionally, it highlights the importance of screening pregnant women for thyroid dysfunction, emphasizing risk factors and potential interventions.

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Hyperthyroidism During Pregnancy

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  1. Hyperthyroidism During Pregnancy Overt hyperthyroidism Subclinical hyperthyroidism

  2. The Most Common Cause of Hyperthyroidism • Graves’ disease • hCG mediated hyperthyroidism • Hyper emesis gravidaraum • Multiple pregnancies • Trophoblastic disease

  3. Changes in thyroid physiology • TBG excess results in high serum total T4 concentrations (not free T4) • High serum hCG results in transient subclinical or overt hyperthyroidism

  4. Pregnancy complications • Spontaneous abortion • Premature labor • Low birth weight • Stillbirth • Preeclampsia • Heat failure • Thyroid storm

  5. Diagnosis • TSH < 0.1 or undetectable • Free T4 • Free T3 • Total T4 • Total T3 • TRAb

  6. Treatment • Indication • Moderate to severe overt hyperthyroidism T4 or T3 > 1.5 times • Thionamids + BetablockersHypoglycemia IUGR • Plasmapheresis • Radioiodine First 2 weeks Spontaneous miscarriage 2 to 12 weeks Birth defects 12 to 14 weeks fetal thyroid ablation

  7. HypothyroidismDuring Pregnancy • Overt hypothyroidism 0.3 - 0.5 • Subclinical hypothyroidism 2 – 2.5

  8. Pregnancy Complications • Preeclampsia and gestational hypertention • Placental abruption • Nonreassuring fetal heart rate tracing • Preterm delivery, including very preterm delivery • Low birth weight • Increased rate of cesarean section • Perinatal morbidity and mortality • Neuropsychological and cognitive impairment • Postpartum hemorrhage

  9. Diagnosis • First trimester 0.1 < TSH < 2.5 • Second trimester 0.2 < TSH < 3 T4 • Third trimester 0.3 < TSH < 3 • TPO in subclinical

  10. The Universal Screening of Asymptomatic Pregnant Women for Thyroid Dysfunction Yes No or

  11. ATA and ACOG recommend targeted case : • From an area of known modarate to severe iodine insufficiency • Have a family or personal history of thyroid disease • Have thyroid peroxidase antibodies • Type 1 diabetes • History of preterm delivery or miscarriage • History of head or neck radiation • BMI ≥ 40 • Infertility • Age > 30 years

  12. Treatment • Indication • Overt moderate to severe 1.6 mcg/kg • TSH < 10 1mcg/kg • Subclinical • Per existing hypothyroidism TSH < 1.2

  13. Positive TPO Complications • Preterm birth • Fetal loss • Perinatal mortality • Large-for-gestational-age infants • Subclinical hypothyroidism • Post partum thyroiditis

  14. Does Positive TPO Need Treatment?

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