Thyroid diseases in pregnancy PPT
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This document discusses thyroid diseases in pregnancy. It notes that normal pregnancy causes physiological changes that alter thyroid function. It then discusses hypothyroidism and hyperthyroidism in pregnancy. Hypothyroidism complicates 1-3/1000 pregnancies and can cause maternal risks like infertility and fetal risks like low IQ. It is managed by replacing levothyroxine. Hyperthyroidism affects 2/1000 pregnancies and can cause maternal risks like heart failure. It is managed medically with antithyroid drugs or surgically with thyroidectomy. Nursing management involves monitoring for recurrence of symptoms postpartum. Preconception counseling is also important.
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Thyroid diseases in pregnancy PPT
- 1. THYROID DISEASES IN PREGNANCY PRESENTED BY, SONAL PATEL, S.Y.M.SC (n), JG COLLEGE (N)
- 2. 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.
- 3. Effects of Pregnancy on Thyroid gland Physiologic Change Thyroid-Related Consequences ↑ Plasma volume ↑ T4 production; ↑ cardiac output First trimester ↑ in hCG ↑ Free T4; ↑ T4 production ↑ T4 production; fetal T4 synthesis during second and third trimesters ↑ Oxygen consumption by feto- placental unit, gravid uterus, and mother ↑ Basal metabolic rate; ↑ cardiac output
- 5. STAGE NORMAL TSH LEVEL First Trimester Less than 2.5mIU/L Second Trimester Less than 3 mIU/L Third Trimester Less than 3 mIU/L
- 8. Definition Hypothyroidism (underactive thyroid) refers to any state in which a person's thyroid hormone production is below normal during Pregnancy. Complicates 1-3/1000 pregnancies.
- 11. Primary hypothyroidism (thyroid gland) 1. Endemic iodine deficiency 2. Radioiodine therapy 3. Thyroidectomy
- 13. Signs
- 15. Maternal Risk Infertility Cardiac dysfunction Spontaneous abortion Pre- eclampsia Placental abruption Low birth weight and stillbirth Prematurity
- 16. Fetal Risk Low IQ Level Cretinism Neonatal or fetal Hypothyroidism Congenital absence of the thyroid gland
- 17. Diagnosis TSH (most sensitive)-Non- pregnant normal range for TSH (0.45-4.5 mIU/ml). Diagnosis of hypothyroidism, elevated TSH and decreased T4. T4: (nomal: 0.7-1.8 mg/dl).
- 19. Management • Replace with Levothyroxine sodium(LT4). • No evidence for additional benefit of T3 replacement • Aim to normalize TSH • Dose adjustment of LT4: • Pregnancy • Weight gain/loss Frank Hypothyroidism (Raised TSH, low FT4)
- 20. Management Subclinical Hypothyroidism (TSH 4-10 mIU/ml & normal Free T4) • LT4 therapy recommended: • Detectable TPOAb (Thyroperoxide Antibodies) • Undectable TPOAb but client symptomatic.(trail of therapy) • Observe without treatment • Negative TPOAb and symptomatic.
- 22. Management • Transfer client to ICU setting: • LT4 using NG tube or IV. • No consensus regarding FT3 therapy. • Supportive Therapy • Steroid cover • Electrolytes/fluid • Antibiotics • Warming • Respiratory support
- 27. Definition Hyperthyroidism (overactive thyroid) is an overproduction of thyroid hormones during Pregnancy. Hyperthyroidism affects 2/1000 pregnancies
- 29. Causes Autoimmune Hyperthyroidism (Graves disease) Functional adenoma Sub acute-thyroiditis Hyperemesis Gravidarum, Trophoblastic disease
- 30. Signs Thyromegaly Diffuse goiter Exophthalmos Pretibial myxedema Increased cardiac output Systolic flow murmur Resting pulse >100 (tachycardia)
- 32. Maternal Risk Congestive heart failure Thyroid storm Pre- eclampsia Fetal Risk,Early pregnancy loss Preterm delivery Infection
- 33. Fetal Risk IUGR LBW Prematurity Stillbirth Hyperthyroidism Hypothyroidism Increased Perinatal morbidity and mortality
- 34. Diagnosis Depressed serum TSH Elevated T4, free T4 , Free T3. T3 Thyrotoxicosis Check TSH receptor antibodies
- 36. Management Medical • Control of Symptoms. • Discontinue once euthyroid. Medical • Control of Hyperthyroidism. • Thionamides (carbimazole, methimazole, propylthiouracil) • Rarely: Potassium iodine, Potassium perchlorate, lithium.
- 38. Nursing Management • Radioactive iodine ablation is contraindicated and women should avoid pregnancy for at least 6 months. • Monitor closely after delivery. • Can get recurrence or aggravation of symptoms first few months. • Check TSH and T4 6 weeks postpartum. • Can breast feed, most medication protein bound.
- 40. Preconception Counseling Considering the hazards during pregnancy, preconceptional counseling is important. Adequate treatment should be instituted to bring down the thyroid function profile to normal. Radioactive iodine therapy should not be given to patients wanting pregnancy within one year. If pregnancy occurs inadvertently, termination should be done. Oral pill is to be withheld because of accelerated metabolism and disturbed liver function.