Thyroid disease is common in pregnancy, affecting 1-2% of women. The thyroid gland produces hormones that regulate metabolism, and changes significantly during pregnancy. Both hypothyroidism and hyperthyroidism can negatively impact the health of the mother and fetus if not properly managed. Graves' disease, which causes hyperthyroidism, accounts for the majority of cases. Uncorrected thyroid dysfunction in pregnancy is associated with risks like preterm birth, low birth weight, fetal loss, and developmental delays.

3. Thyroid Disease in
Pregnancy

4. INTRODUCTION
 The thyroid, or thyroid gland, is an endocrine
gland in the neck consisting of two connected
lobes. The lower two thirds of the lobes are
connected by a thin band of tissue called the
thyroid isthmus. The thyroid is located at the front
of the neck, below the Adam's apple.
 Thyroid,derived from Greek word -means shield
gland.
 Highly vascular organ
 Brownish red ,2lobes (4.2cm)and one isthmus
2.2cm.
 30%have pyramidal lobe.
 weight- 15-20gm.

5. INCIDENCE
 Most common endocrine disorder in
pregnancy.
 Effects 1-2% pregnant women.
 Hypothyroidism- 0.05%
 Hyperthyroidism- 0.05-0.2% (Grave’s – 90%)
 Postpartum thyroiditis- 5-10%

6. DEVELOPMENT
Fetal thyroid:-
 From as a midline outpouching of
the anterior pharyngeal floor,
migrates and reaches its final
position by 7 weeks .
 Lateral contributions from the 4th
and 5th pharyngeal pouches give
its bilateral shape by week 8-9 .

7. CHANGES DURING PREGNANCY
 20% increase in thyroid gland size due to
hyperplasia and increased vascularity.
 Increase in Estrogen: increased TBG,(Thyroxine
binding globulin ) decreased Free T4
 HCG rise: Structural similarity with TSH: increase
in T4/ T3, decrease in TSH
 Increased peripheral metabolism of thyroid
hormones: Placenta: type II /III deiodinases Fetus
dependent on Type II for T4 T3
 Decline in availability of iodide related to increased
renal clearance and overall losses to the fetus and
placenta .

8. Physiologic Changes in Thyroid
Function During Pregnancy
Maternal
Status
TSH
**initial
screening
test**
Free T4 Free
Thyroxine
Index
(FTI)
Total T4 Total T3 Resin
Triiodo-
thyronine
Uptake
(RT3U)
Pregnancy No
change
No
change
No
change
Increase Increase Decrease
Hyperthyroidism Decrease Increase Increase Increase Increase
or no
change
Increase
Hypothyroidism Increase Decrease Decrease Decrease Decrease
or no
change
Decrease

13. Hyperthyroidism
 Occurs in 0.2% of
pregnancies; Graves’
disease accounts for
95% of cases
Look for:
-Nervousness
-Tremor
-Tachycardia
-Frequent stools
-Sweating
-Heat intolerance
-Weight loss
-Goiter
-Insomnia
-Palpitations
-Hypertension
-Lid lag/lid retraction
-Pretibial myxedema

14. RISK FACTORS

15. Fetal & Neonatal Effects of Hyperthyroidism
 Associated with preterm delivery, low birth
weight, fetal loss
 Fetal thyrotoxicosis (related to disease itself or
treatment)
 Risk of immune-mediated
hypo/hyperthyroidism (due to antibodies
crossing the placenta, esp. in Graves or
chronic autoimmune thyroiditis)
 Antibodies in Graves’ disease can be either
stimulatory or inhibitory
Neonates of women with Graves’ who have been
surgically/radioactively treated are at higher risk,
b/c not taking suppression

16. Causes & Diagnosis of Hyperthyroidism
 Most common cause of hyperthyroidism is Graves’
disease
 Document elevated FT4 or elevated FTI with
suppressed TSH, in absence of goiter/mass
 Most patients have antibodies to TSH receptor,
antimicrosomal,or antithyroid peroxidase antibodies, but
measurement of these is not required (though some
endocrinologists recommend measuring TSI, which are
stimulatory antibodies to TSH receptor)
Other causes:
 Excess TSH production, gestational trophoplastic
disease, hyperfunctioning thyroid adenoma, toxic
goiter, subacute thyroiditis, extrathyroid source of TH .

20. SIGH/SYMPTOM
HAND OUT

21. CLINICAL MANIFESTATIONS
 Bradycardia
 Thickened skin
 Cardiac complication
 Weight gain

22. EFFECTS
on pregnancy
 Prolonged infertility
 Recurrent aboration
 Preeclampsia 5-10
 Placenta abruption 1%
 Preterm delivery 10-15%
 Anemia
 Myxedema coma
 Malpresentation
 LBW
 PPH
 Still birth

23. EFFECTS ON FETUS
 Neurodevelopmental delay
 Deafness
 Stunted growth
 Peripartum hypoxia
 Neonatal mortality

31. CONCLUSION
Thyroid disease in pregnancy can affect the health of
the mother as well as the child before and after delivery.
Thyroid disorders are prevalent in women of child-
bearing age and for this reason commonly present as a
pre-existing disease in pregnancy, or after childbirth.
Uncorrected thyroid dysfunction in pregnancy has
adverse effects on fetal and maternal well-being.

32. BIBLIOGRAPHY
• Dutta DC.Text book of obstetrics including perinatal
and contraception central publication 7th edition
jaypee brothers medical publishers (p)LTD New delhi,
pg no-
• Jacob annama,text book of comprehensive text book
of midwify and gynecology nursing jaypee
publication3rd edition jaypee brothers medical
publishers (p)LTD New delhi,
pg no-
• https://en.wikipedia.org/wiki/Thyroid disease in
pregnancy
• https://www.thyroid.org/thyroid-disease-pregnancy
• https://www.slideshare.net/ikramdr01/thyroid-diseases-
in-pregnancy