This document discusses hyperthyroidism during pregnancy. It covers the incidence, types, causes, clinical features, laboratory diagnosis, effects of pregnancy on thyrotoxicosis and vice versa, and management. The most common cause is Graves' disease. Left untreated, thyrotoxicosis can cause complications for both mother and fetus like miscarriage. Treatment involves antithyroid medications like PTU or carbimazole to maintain euthyroidism while minimizing risk to the fetus. Surgery and radioactive iodine are generally avoided during pregnancy. Careful monitoring is needed to balance control of the mother's condition and fetal well-being.
A normal pregnancy results in a number of important reversible physiological and hormonal changes that alter thyroid structure and more importantly function.
Understanding these change are important to interpreting, identifying and managing of thyroid disease in pregnancy.
A normal pregnancy results in a number of important reversible physiological and hormonal changes that alter thyroid structure and more importantly function.
Understanding these change are important to interpreting, identifying and managing of thyroid disease in pregnancy.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Thyroid disease in_pregnancy
Presented by: Dr. Ahmad mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Thyroid disease in_pregnancy
Presented by: Dr. Ahmad mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Hyperthyroidism, Reference: Hyperthyroid, Harrison's Principles of Internal Medicine, Soheil Elahi, Islamic Azad University of Medicine- International Branch (IAUM-int)
Awareness Anesthesia occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and subsequently has recall of these events
Thyroid Disorder:
Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental abruption, hypertensive disorders, and growth restriction.
Types of thyroid disorder incidence in pregnancy:
1. Hypothyroidism 0.05%
2. Hyperthyroidism 0.05-0.2%
3. Postpartum thyroiditis 5-10%
Signs:
Hair loss
Sweating
Irritability
Bulging eyes
Rapid heart beat
Nervousness
Tremor of fingers
Difficulty sleeping
Weight loss
Hypothyroidism is a condition marked by an underactive thyroid gland and may be present during pregnancy. It incidence
0.05% of pregnant women
31% positive for TPO Ab
Associated with Gest Hypertension.
Hyperthyroidism in pregnancy:
Hyperthyroidism is characterized by high level of serum thyroxine and triiodothyronine, low levels of thyroid-stimulating hormones.
Hyperthyroidism during pregnancy usually is caused by an
Autoimmune disorder called Grave’s disease. It incidence :-
- 0.2% of pregnant women
- 95% Grave’s disease
It is a presentation on Thyroid Disorder in Pregnancy 2023
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. 1. INCIDENCE AND TYPES
2. CAUSES
3. CLINICAL FEATURES
4. LABORATORY DIAGNOSIS
5. EFFECT OF PREGNANCY ON
THYROTOXICOSIS
6. EFFECT OF THYROTOXICOSIS ON
PREGNANCY
7. MANAGEMENT
ABOUBAKR ELNASHAR
3. 1. INCIDENCE AND TYPES
•Women>men (10:1).
•1 in 500 pregnancies.
•50%: family history of autoimmune thyroid disease.
•Most cases encountered in pregnancy have already
been diagnosed and will already be on tt.
•If thyrotoxicosis occurs for the 1st time in pregnancy, it
usually presents late in 1st or early in 2nd trimester.
ABOUBAKR ELNASHAR
4. TSH FT4 FT3 TT4 TT3
Pregnancy
No
change
No
change
↑ ↑ ↑
Overt
Hyperthyroidism
↓ ↑ ↑ ↑ ↑
Subclinical
hyperthyroidism
↓
No
change
No
change
No
change
No
change
ABOUBAKR ELNASHAR
5. Gestational hyperthyroidism
1-3% of all pregnancies
{stimulation of TSH receptors by b-hCG}.
DD from Graves disease:
Free T4 levels raised
TSH receptor antibodies are negative
F T4 levels return to normal in 2nd T
Management
Supportive management
Thyroid replacement is not indicated.
ABOUBAKR ELNASHAR
6. 2. CAUSES
•95%: Graves' disease.
(autoimmune disorder caused by TSH receptor-
stimulating antibodies).
These autoantibodies cross the placenta: fetal and
neonatal thyroid dysfunction even when the mother
herself is in a euthyroid condition.
up to 1% of pregnancies
ABOUBAKR ELNASHAR
9. 3. CLINICAL FEATURES
Many features are common in
normal pregnancy:
heat intolerance, tachycardia,
palpitations, palmar erythema,
emotional lability, vomiting and
goitre.
Discriminatory features:
weight loss
tremor
persistent tachycardia
lid lag, exophthalmos
ABOUBAKR ELNASHAR
10. Eye signs
50%
{thyroid disease at some
time rather than active
thyrotoxicosis, may occur
before hyperthyroidism}
ABOUBAKR ELNASHAR
11. 4. LABORATORY DIAGNOSIS
•Overt:
Raised FT4 or FT3, decreased TSH
•Subclinical:
Decreased TSH, normal FT4 and FT3
an abnormally suppressed TSH accompanied by a normal FT4 level.
1.5% of pregnant women
No adverse outcomes: not to check thyroid
function tests routinely.
ABOUBAKR ELNASHAR
12. American Thyroid Association (2014):
1. Subclinical hyperthyroidism
TSH: 0.1-0.2 mIU/L with normal FT4.
2. Overt hyperthyroidism
TSH: < 0.2 mIU/L accompanied by high FT4 OR
TSH < 0.1 mIU/L irrespective of FT4 level.
ABOUBAKR ELNASHAR
13. Screening for Maternal thyroid antibodies:
1. Graves’ disease
with fetal or neonatal hyperthyroidism in a previous
pregnancy
Active Graves’ disease being treated with antithyroid
drugs
2. Euthyroid or have undergone ablative therapy and
have fetal tachycardia or IUGR
3. Chronic thyroiditis without goiter
4. Fetal goiter on ultrasound.
Screening for Neonatal thyroid antibodies:
congenital hypothyroidism
ABOUBAKR ELNASHAR
14. 5. EFFECT OF PREGNANCY ON
THYROTOXICOSIS
1. Exacerbations may occur in:
1st trimester {hCG production}
Puerperium {reversal of the fall in antibody levels seen
during pregnancy}.
2. Improvement: lower requirement for antithyroid tt
during 2nd and 3rd trimesters.
{As with other autoimmune conditions, there is a state of
relative immunosuppression in pregnancy and levels of TSH
receptor-stimulating antibodies may fall}
3. Pregnancy has no effect on Graves'
ophthalmapathy.
ABOUBAKR ELNASHAR
15. 6. EFFECT OF THYROTOXICOSIS ON
PREGNANCY
Severe untreated: inhibition of ovulatian and
infertility.
Well controlled or
previously treated Graves' disease in remission:
No effect on maternal and fetal outcome
ABOUBAKR ELNASHAR
16. Untreated:
1. increased rate of
Miscarriage
IUGR, PTL
perinatal mortality,
congestive heart failure,
PET.
2. Thyroid crisis ('storm') and heart failure, particularly at
the time of delivery.
3. Retrosternal extension of a goitre:
tracheal obstruction.
This is a particular problem if the patient needs to be
intubated.
rare
ABOUBAKR ELNASHAR
17. 4. Fetal or neonatal thyrotoxicosis
{Thyroid stimulating antibodies }
Neonates of women with definitively treated Graves’
disease (status post thyroidectomy or tt with I131 before
pregnancy) have a higher risk of neonatal Graves disease
compared with women with Graves disease currently on
thioamide tt during pregnancy.
{1. definitively treated women still have thyroid stimulating
antibodies that cross the placenta and could affect the fetus
but they have no concurrent thioamide treatment, a drug that
also crosses the placenta
2. we tend to forget these women had Graves disease
because they are on thyroid replacement and, in our minds,
they are labeled as having hypothyroidism}
ABOUBAKR ELNASHAR
18. THYROID STORM
Rare:
1% to 2% of patients receiving thioamide therapy.
In most instances:
a complication of uncontrolled hyperthyroidism,
Precipitated by:
infection
surgery
Thromboembolism
PET
labor, and delivery.
ABOUBAKR ELNASHAR
20. Treatment:
Should be initiated before the results of TSH, FT4,
and FT3 tests are available.
Delivery should be avoided, if possible, until the
mother’s condition can be stabilized but, if the status
of the fetus is compromised, delivery is indicated.
Begin with stabilization of the patient, followed by
initiation of a stepwise management approach
ABOUBAKR ELNASHAR
22. 7. MANAGEMENT
Preconception care
1. Achieve euthyroidism before pregnancy.
2. Conception should be delayed for 6 months after
radioactive iodine therapy.
3. Propylthiouracil (PTU) is the preferred agent
{lower levels of teratogenicity}
Am thyroid Society: change to carbimazole in 2nd T
{PTU-associated hepatotoxicity in offspring}.
4. Doses should be kept at the lowest possible level
to achieve euthyroidism.
ABOUBAKR ELNASHAR
23. During pregnancy
Pregnant women with overt hyperthyroidism should
be treated with thioamide to minimize risk adverse
outcomes
(ASRM, 2015).
FT4 should be monitored in pregnant women with
hyperthyroidism and thioamide dose adjusted
accordingly.
(ASRM, 2015).
ABOUBAKR ELNASHAR
24. Antithyroid drugs
Mechanism of action:
PTU:
Blocks the oxidation of iodine in the thyroid gland:
prevent synthesis of T4 and T3.
Methimazole:
blocks the organification of iodide: decreases thyroid
hormone production.
ABOUBAKR ELNASHAR
25. Relapse rates are high
Some women are managed with long-term
antithyroid drugs.
Maintenance (12-18 m)Initial (4-6 w)Dose
5-15 mg15-40 mgCarbimazole
50-150 mg150-400 mgPTU
ABOUBAKR ELNASHAR
26. The aim of treatment:
1. Control the thyrotoxicosis as rapidly as possible
2. Maintain optimal control 'with the lowest dose of
antithyroid medication.
Monitoring:
-The woman should be clinically euthyroid
-FT4 at the upper end of the normal range.
=Thyroid function:
/4 w (until TSH and FT4 are within normal)
/trimester thereafter.ABOUBAKR ELNASHAR
27. Side effects:
1. Maternal:
a. Rash or urticaria (1-5%)
b. Carb: ±neutropenia and agranulocytosis (Rare)
Women should be asked to report any signs of
infection (sore throat):
CBC: neutropenia: stop Carb
ABOUBAKR ELNASHAR
28. 2. Foetal:
a. High doses: fetal hypothyroidism and goitre
{Both drugs cross the placenta, PTU< Carb}
No place for 'block-and-replace' regimens.
Thyroxine 'replacement' does not cross the
placenta in doses to protect the fetus.
b. Neither is grossly teratogenic, although Carbim
occasionally: scalp defect (aplasia cutis).
•Doses of
PTU 150 mg/d
Carb 15 mg/d: unlikely to cause F problems
ABOUBAKR ELNASHAR
29. 3. During lactation:
•Very little PTU (0.07%) and carb (0.5%) is excreted
in breast milk: safe PTU 150 mg/d and Carb 15 mg/d
•High doses of antithyroid drugs: Thyroid function
should be checked in umbilical cord blood and at
regular intervals in the neonate
•PTU is preferable for newly diagnosed cases in
pregnancy
{less transfer across the placenta and to breast milk}
but women already on maintenance Carb prior to
pregnancy need not be switched to PTU in
pregnancy.
ABOUBAKR ELNASHAR
30. βBlockers
•Indications:
1. Early management of thyrotoxicosis
2. Relapse {prove sympathetic symptoms of
tachycardia, sweating and tremor}.
•Stop once there is Cl improvement, usually evident
within 3 ws.
•Doses:
40 mg tds for such short periods of time: not harmful
to the fetus.
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31. Surgery (Thyroidectomy)
Indications: Rare
1. Dysphagia or stridor related to a large goitre.
2. Confirmed or suspected carcinoma.
3. Allergies to both antithyroid drugs.
Best performed in: 2nd trimester.
Complications:
1. Hypothyroidism (25-50%)
close follow-up to ensure rapid diagnosis and tt with
replacement therapy.
2. Hypocalcaemia
{removal of the parathyroid glands}
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32. Radioactive iodine
Contraindicated:
1. Pregnancy
•Pregnancy should be avoided for at least 4 months
after tt
{risk of chromosomal damage and genetic
abnormalities}.
2. Breast-feeding
{it is taken up by the fetal thyroid (after 10-12w):
thyroid ablation and hypothyroidism}.
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33. Diagnostic radioiodine scans (as opposed to tt)
contraindicated in pregnancy
±performed in breast-feeding:
stop breast-feeding for 24 h after the procedure.
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