THYROID DISEASE IN

PREGNANCY

Dr.Zil-e-Haider Syed
Gynae & Obstetrics unit II
Thyroid function in Normal pregnancy
Reletive iodine deficiency state
increased renal loss
transfer to fetus
TSH
alpha subunit mimicker
range broader and higher
TBG
increased estrogen increased TBG
T4
hcg spillover..increased levels in early gestation

Hyperemesis gravidarum and molar pregnancy

increased hcg…..increased T4 n decreased TSH
TFTs during pregnancy
Hyperthroidism
Prevalance

o 0.2% of pregnant women

o 95% Grave’s disease
Diagnosis

o symptoms/signs……. Lid lag, lid retraction,

weight loss, palmer erythema ,emotional
liability ,tremors ,persistent tachycardia,
vomiting ,goiter, heat intolerance
o TFTS
elevated free T4 T3 levels and depressed TSH
Maternal risks

Heart failure
Thyroid storm
Miscarriages
Growth restriction
Preterm labour
Placental abruption
PIH,preclampsia
Infection
Increased risk of congenital anomalies
o Fetal or neonatal thyrotoxicosis
Fetalrisks

Intrapartum assessment
persistent tachycardia
Goiter on ultrasound
Growth restriction
Neonatal diagnostic features
exophthalmoses
hepatosplenomegly
thrombocytopenia
Goiter
Growth restriction
Heart failure(hydrops fetalis)
Jaundice
Poor feeding
Poor weight gain
irritability
Management
PREPREGNANCY
Hypomenorhagia, Oligomenorrhea

Patient having radioiodine

Counseling and reassurance

Prenatal
o Euthyroid clinical state(T4 at upper limit of normal)
o TFTs monthly
o Choice of drug
Thyonamides(Carbimazole
Propylthouracil)
Propanalol
Iodine treatment
Radioactive iodine

o Surgery
Labour and delivery
o Adequately treated woman…..no increased risks
o Thyroid storm
exaggerated features of hyperthyroidism
Hyperpyrexia
CCF
Dysrythmias
Altered mental status
o Treatment of thyroid storm
1.to decrease thyroid hormone production( thionamides and iodine)
2.to decrease effect of circulating hormone(propyl thyouracil)
3.to provide supportive therapy
(ivfluids,propanalol,hydrocortisone)
4.to treat underlying cause
Postnatal
o Care of neonate

o Breast feeding

o Watch for maternal worsening of symptoms

THANKS