1. Dr.Zil-e-Haider Syed
Gynae & Obstetrics unit II
THYROID DISEASE IN
PREGNANCY

2. 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

3. TFTsduring pregnancy

4. Hyperthroidism

5. Prevalance
o 0.2% of pregnant women
o 95% Grave’s disease

6. 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

7. Maternal risks
 Heart failure
 Thyroid storm
 Miscarriages
 Growth restriction
 Preterm labour
 Placental abruption
 PIH,preclampsia
 Infection
 Increased risk of congenital anomalies

8. Fetal risks
o Fetal or neonatal thyrotoxicosis
 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

9. Management
PREPREGNANCY
Hypomenorhagia, Oligomenorrhea
Patient having radioiodine
Counseling and reassurance

10. 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

11. Labourand 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

12. Postnatal
o Care of neonate
o Breast feeding
o Watch for maternal worsening of symptoms

13. THANKS