The document discusses thyroid physiology and function during pregnancy. It notes that the hypothalamus-pituitary-thyroid axis is regulated by negative feedback, with TRH and TSH levels inversely related to T3 and T4 levels. During pregnancy, thyroid function is impacted due to increases in TBG, TT4, and TT3 to support fetal development. The document outlines screening recommendations for hypothyroidism in pregnancy, treatment with levothyroxine to maintain normal TSH levels, and potential complications of untreated maternal hypothyroidism such as preterm birth, low birth weight, and impaired neurodevelopment.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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.
hyperthyroidism, thyrotoxicosis, grave disease, thyroid storm, pregnancy, high risk pregnancy, pregnancy complications, management of thyrotoxicosis and thyroid storm in pregnancy
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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.
hyperthyroidism, thyrotoxicosis, grave disease, thyroid storm, pregnancy, high risk pregnancy, pregnancy complications, management of thyrotoxicosis and thyroid storm in pregnancy
Imapct of Thyroid disorder on Reproduction-DrSelim.pdfShahjadaSelim1
Thyroid disorders are the commonest endocrine disorders in all people, though less talked about.
Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy but more common than Diabetes in the community.
Female related infertility accounted for 37% and combined male and female factors for 35% of the causes of infertility.
I am Dr Pendo Chaula, a senior resident at University of Dodoma in Tanzania. I am working at UDOM affiliated hospitals which are Benjamin Mkapa hospital, UDOM hospital, Dodoma regional referral hospital and Iringa regional referral Hospital. Am posting it for learning purpose, you can download it if you like it
overview of anatomy and physiology of the thyroid gland,fetal period and pregnancy physiological changes ....then overview of congenital hypothyroidism plus management
Thyroid and Pregnancy, Review of PhysiologyUsama Ragab
Thyroid and Pregnancy
Facts and Messages
A series of changes in thyroid hormone economy take place in normal pregnancy.
As a result of these changes, thyroid hormone levels in pregnancy differ from those in the non-pregnant state.
Discusses how maternal thyroid physiology changes in pregnancy, the issues of thyroid disease in pregnancy, how to interpret thyroid test results in the pregnant woman and how to manage common thyroid diseases in pregnancy
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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
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.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
Follow us on: Pinterest
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Control of thyroid function
by a negative-feedback loop:
•The hypothalamus releases TRH
•TRH acts on the pituitary gland to release TSH
•TSH acts on the thyroid gland to release the thyroid hormones (T3
and T4) that regulate metabolism
•TRH and TSH concentrations are inversely related to T3 and T4
concentrations.
•99% circulating T3 and T4 is bound to TBG.
1% circulate in the free form,
and only the free forms are biologically active.
ABOUBAKR ELNASHAR
4. Physiological changes of thyroid during pregnancy
1. TBG
Increase {hepatic synthesis is increased}
2. TT4 & TT3
increase to compensate for this rise
3. FT4 & FT3
decrease.
FT4 are altered less by pregnancy, but do fall a little in the
2nd & 3rd trimesters.
4. TSH
decrease in 1st trimester, between 8 & 14 ws {increase
HCG, HCG has thyrotropin-like activity},
increase in 2nd & 3rd trimester {Increased TBG}ABOUBAKR ELNASHAR
5. 5. Pregnancy is associated with a state of relative iodine
deficiency
{a. increase maternal iodine requirement because of active
transport to fetoplacental unit
b. Increase iodine excretion in urine, 2 fold, because of
increased GFT & decreased renal tubular reabsorption}
The thyroid gland increases its uptake from the blood 3 fold
{fall of plasma iodine}
If there is already dietary insufficiency of iodine, the thyroid
gland hypertrophies in order to trap a sufficient amount of
iodine
ABOUBAKR ELNASHAR
8. Fetal thyroid function
•During early gestation: the fetus receives thyroid hormone from the
mother.Maternal T4 crosses the placenta actively, the only hormone
that does so. (T3, TSH)
•The fetus’s need for thyroxine starts to increase as early as 5 ws of
gestation.
Fetal thyroid development does not begin until 10 to 12 ws, and then
continues until term.
The fetus relies on maternal T4 exclusively before 12 ws & partially
thereafter for normal fetal neurologic development.
•Maternal hypothyroidism could be detrimental to fetal development if
not detected and corrected very early in gestation. Preconceptual
optimization of T4 therapy is important (III)
ABOUBAKR ELNASHAR
10. Incidence
Much more common in women than men
Common in those with family history
Overt hypothyroidism:
0.3% - 2.5% of pregnancies
active intervention is required to prevent serious damage
to the fetus.
Subclinical disease:
2% to 3% of pregnancies
Current research indicates that intervention may be
indicated.
ABOUBAKR ELNASHAR
11. Causes
•Iodine deficiency:
most common cause in most of the world
•Hashimoto’s thyroiditis (chronic autoimmune thyroiditis):
most common cause in developed countries, where lack of
iodine in the diet is not a problem
characterized by:
antithyroid antibodies (thyroid antimicrosomial and
antithyroglobulin antibodies).
Both iodine deficiency and Hashimoto’s thyroiditis are
associated with goiter.
ABOUBAKR ELNASHAR
13. •Iodine and lithium inhibit thyroid function and, along with
dopamine antagonists, increase TSH levels.
•Thioamides, glucocorticoids, dopamine agonists, and
somatostatins decrease TSH levels.
•Ferrous sulfate, sucrafate, cholestyramine, and aluminum
hydroxide antacids all inhibit GIT absorption of thyroid
hormone and therefore should not be taken within 4 hrs of
thyroid medication.
ABOUBAKR ELNASHAR
14. Screening
•Routine screening has been recommended:
infertility
menstrual disorders
Repeated pregnancy loss (RCOG do not recommend)
Type 1 DM,
Pregnant women who have S&S of deficient thyroid function.
•In recent years, some authors have recommended
screening all pregnant women for thyroid dysfunction, but
such recommendations remain controversial.
•Routine screening is not endorsed by the ACOG
ABOUBAKR ELNASHAR
15. Clinical pictures
• Similar to physiologic conditions seen in most pregnancies.
•Fatigue, constipation, cold intolerance, muscle cramps, hair loss, dry
skin, brittle nails, weight gain, intellectual slowness, bradycardia,
depression, insomnia, periorbital edema, myxedema, and myxedema
coma
SYMPTOM HYPOTHYROIDISM PREGNANCY
Fatigue o o•
Constipation •0 •o
Hair loss o•
Dry skin •o
Brittle nails •o
Weight gain •o o•
Fluid retention •o •o
Bradycardia •o •
Goiter •o o
Carpal tunnel
syndrome •o o•
ABOUBAKR ELNASHAR
17. laboratory tests
Because screening is controversial and symptomatology
does not reliably distinguish hypothyroidism from normal
pregnancy, laboratory tests are the standard for diagnosis.
Overt hypothyroidism:
symptomatic patient
elevated TSH level
low levels of FT4 and FT3.
Subclinical hypothyroidism:
asymptomatic patient.
elevated TSH
normal FT4 and FT3
ABOUBAKR ELNASHAR
18. Effects of hypothyroidism on pregnancy
The impact of maternal hypothyroidism on the fetus depends
on the severity of the condition.
A. Uncontrolled hypothyroidism.
Miscarriage
Anaemia
Intrauterine fetal demise and stillbirth
preterm delivery,
low birth weight,
preeclampsia,
developmental anomalies including reduced IQ.
ABOUBAKR ELNASHAR
19. •Maternal and congenital hypothyroidism resulting from
severe iodine deficiency:
profound neurologic impairment & mental retardation.
•If the condition is left untreated.
Congenital cretinism:
Growth failure, mental retardation, and other
neuropsychologic deficits including deaf-mutism.
•If cretinism is identified & treated in the first 3 months of life:
near-normal growth and intelligence can be expected.
•For this reason, newborn screening for congenital
hypothyroidism.
ABOUBAKR ELNASHAR
20. B. Asymptomatic overt hypothyroidism.
Women who had previously been diagnosed with hypothyroidism,
(abnormal TSH and FT4 levels), but who do not have symptoms.
1. Impaired psychomotor development at 10 months in infants born to
mothers who had low T4 during the first 12 ws of gestation (Pop et
al,1999)
2. low IQ scores in the offspring at 7 to 9 yrs of age was correlated
with elevated maternal TSH levels at less than 17 weeks’ gestation
(Haddow et al, 1999).
An inverse correlation between a woman’s TSH level during
pregnancy and the IQ of her offspring (Klein et al, 1991).
and colleagues confirmed that maternal hypothyroxinemia is a risk for
neurodevelopmental abnormalities that can be identified as early as 3
weeks of age (Kooistra et al, 2006)
ABOUBAKR ELNASHAR
21. C. Subclinical hypothyroidism.
•Low IQs of the children whose mothers were not treated
(Mitchell and Klein, 2004).
•Undiagnosed subclinical hypothyroidism were more likely
to be complicated by
placental abruption
preterm birth (Casey, 2005).
ABOUBAKR ELNASHAR
23. Treatment
The treatment of choice is synthetic T4, or levothyroxine
(Levothyroid, Levoxyl, Synthroid, and Unithroid).
Non pregnant:
1.7 μg/kg/day or
12.5 to 25 μg/day adjusted by 25 μg/day every 2 to 4 ws
until euthyroid state is achieved.
ABOUBAKR ELNASHAR
24. •Pregnant:
Safe in pregnancy and lactation [II]. {Very little thyroxin
crosses the placenta and the fetus is not at risk of
thyrotoxicosis}
•Patients who were on thyroxine therapy before pregnancy
should increase the dose by 30% once pregnancy is
confirmed (Bombrys et al, 2008)
•Monitoring:
TSH should be monitored /4 ws
to maintain a TSH level between 1 and 2 mU/L and FT4 in
upper third of normal.
•Once euthyroid state has been achieved, TSH should be
monitored /trimester until delivery.ABOUBAKR ELNASHAR
25. The following upper-normal reference ranges are
recommended:
1st T: 2.5 mIU/L
2nd T3.0 mIU/L
3rd T: 3.5 mIU/L.
American Association of Clinical Endocrinologists and the American Thyroid
Association, 2013
ABOUBAKR ELNASHAR