The document discusses thyroid dysfunction in pregnancy, including physiological changes in the thyroid gland during pregnancy, screening and management of hypothyroidism and hyperthyroidism, and the effects of thyroid disorders and iodine deficiency on maternal and fetal health. Key points covered include the increased demand for thyroid hormones during pregnancy, screening guidelines for thyroid disorders, and treatment approaches for hypothyroidism including levothyroxine dosage optimization.
THYROID DISEASES IN PREGNANCY BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses thyroid disorders in pregnancy. It provides information on thyroid physiology changes during pregnancy, screening and management of thyroid dysfunction. Key points include: thyroid hormones play a key role in fetal development; pregnancy causes changes in thyroid binding globulin, placental conversion of T4 to reverse T3, and increased renal clearance of thyroid hormones; screening is recommended for high risk women and with a TSH cutoff of 2.5 mIU/L in the first trimester. Management involves treatment of hypothyroidism and hyperthyroidism to prevent complications of each condition for both mother and fetus.
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.
This document discusses several autoimmune and endocrine conditions that can affect pregnancy, including their presentation, diagnosis, and management. It covers thyroid disease, rheumatoid arthritis, immune thrombocytopenic purpura, myasthenia gravis, and systemic lupus erythematosus. For each condition, it describes associated risks for the mother and fetus, as well as recommendations for treatment and monitoring during pregnancy and delivery. The goal is to maintain maternal and fetal health while minimizing medication exposure for the baby.
Hypothyroidism in pregnancy by DR ALKA MUKHERJEE DR APURVA MUKHERJEE NAGPUR M.S.alka mukherjee
Pregnancy is a period that places great physiological stress on both the mother and the fetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse fetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in influencing outcomes in a euthyroid woman, also needs further clarification. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a flare up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case finding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early confirmation of diagnosis and prompt treatment. Allied with regular post-partum follow up, is required to ensure favourable maternal and fetal outcomes.
Thyroid physiology is perceptibly modified during normal pregnancy. These alterations take place throughout gestation, help to prepare the maternal thyroid gland to cope with the metabolic demands of pregnancy, are reversible post-partum and the interpretation of these changes can pose a challenge to the treating physician.
1. Thyroid disorders are common in pregnancy, affecting 1-2% of pregnant women. Optimal management is important for pregnancy outcomes.
2. Hypothyroidism and hyperthyroidism can cause complications for both mother and fetus if not treated properly. Levothyroxine is the treatment of choice for hypothyroidism. Antithyroid drugs are used to treat hyperthyroidism.
3. Factors like hCG and estrogen increase thyroid function in pregnancy, requiring adjustments to diagnosis and treatment of thyroid disorders compared to non-pregnant individuals. Monitoring of thyroid levels is important during and after pregnancy.
1. Thyroid function changes during pregnancy due to increases in thyroid binding globulin, human chorionic gonadotropin, and other factors. This can cause hyperthyroidism or hypothyroidism.
2. Hyperthyroidism occurs in 0.2% of pregnancies, often due to Graves' disease. It increases risk of complications. Hypothyroidism occurs in 2-3% and also increases risks if not treated.
3. Postpartum thyroiditis involves transient hyperthyroidism and/or hypothyroidism after delivery. Long term hypothyroidism can occur. Thyroid cancer diagnosis and treatment requires consideration of pregnancy.
The document discusses the effects of pregnancy on thyroid physiology and function. It notes that thyroid stimulating hormone (TSH) levels are initially suppressed in the first trimester due to increased human chorionic gonadotropin (hCG) but become a reliable indicator again later in pregnancy. It provides references ranges for TSH, free T4, and total T4 in pregnancy and discusses screening and treatment of hypothyroidism. Maternal hypothyroidism can impact both maternal and fetal health outcomes.
The document discusses thyroid disease in pregnancy. It describes the physiological changes in thyroid function during pregnancy, including increases in thyroid binding globulin and thyroid hormone levels. It covers the signs, symptoms, risks and treatment of both hyperthyroidism and hypothyroidism in pregnancy. For hyperthyroidism, the most common cause is Graves' disease. Risks include early pregnancy loss, fetal growth issues, and neonatal hyperthyroidism. Treatment involves antithyroid medications. For hypothyroidism, the most common causes are Hashimoto's thyroiditis and iodine deficiency. Risks include infertility, miscarriage, and impaired neurodevelopment. Treatment is levothyroxine supplementation.
THYROID DISEASES IN PREGNANCY BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses thyroid disorders in pregnancy. It provides information on thyroid physiology changes during pregnancy, screening and management of thyroid dysfunction. Key points include: thyroid hormones play a key role in fetal development; pregnancy causes changes in thyroid binding globulin, placental conversion of T4 to reverse T3, and increased renal clearance of thyroid hormones; screening is recommended for high risk women and with a TSH cutoff of 2.5 mIU/L in the first trimester. Management involves treatment of hypothyroidism and hyperthyroidism to prevent complications of each condition for both mother and fetus.
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.
This document discusses several autoimmune and endocrine conditions that can affect pregnancy, including their presentation, diagnosis, and management. It covers thyroid disease, rheumatoid arthritis, immune thrombocytopenic purpura, myasthenia gravis, and systemic lupus erythematosus. For each condition, it describes associated risks for the mother and fetus, as well as recommendations for treatment and monitoring during pregnancy and delivery. The goal is to maintain maternal and fetal health while minimizing medication exposure for the baby.
Hypothyroidism in pregnancy by DR ALKA MUKHERJEE DR APURVA MUKHERJEE NAGPUR M.S.alka mukherjee
Pregnancy is a period that places great physiological stress on both the mother and the fetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse fetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in influencing outcomes in a euthyroid woman, also needs further clarification. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a flare up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case finding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early confirmation of diagnosis and prompt treatment. Allied with regular post-partum follow up, is required to ensure favourable maternal and fetal outcomes.
Thyroid physiology is perceptibly modified during normal pregnancy. These alterations take place throughout gestation, help to prepare the maternal thyroid gland to cope with the metabolic demands of pregnancy, are reversible post-partum and the interpretation of these changes can pose a challenge to the treating physician.
1. Thyroid disorders are common in pregnancy, affecting 1-2% of pregnant women. Optimal management is important for pregnancy outcomes.
2. Hypothyroidism and hyperthyroidism can cause complications for both mother and fetus if not treated properly. Levothyroxine is the treatment of choice for hypothyroidism. Antithyroid drugs are used to treat hyperthyroidism.
3. Factors like hCG and estrogen increase thyroid function in pregnancy, requiring adjustments to diagnosis and treatment of thyroid disorders compared to non-pregnant individuals. Monitoring of thyroid levels is important during and after pregnancy.
1. Thyroid function changes during pregnancy due to increases in thyroid binding globulin, human chorionic gonadotropin, and other factors. This can cause hyperthyroidism or hypothyroidism.
2. Hyperthyroidism occurs in 0.2% of pregnancies, often due to Graves' disease. It increases risk of complications. Hypothyroidism occurs in 2-3% and also increases risks if not treated.
3. Postpartum thyroiditis involves transient hyperthyroidism and/or hypothyroidism after delivery. Long term hypothyroidism can occur. Thyroid cancer diagnosis and treatment requires consideration of pregnancy.
The document discusses the effects of pregnancy on thyroid physiology and function. It notes that thyroid stimulating hormone (TSH) levels are initially suppressed in the first trimester due to increased human chorionic gonadotropin (hCG) but become a reliable indicator again later in pregnancy. It provides references ranges for TSH, free T4, and total T4 in pregnancy and discusses screening and treatment of hypothyroidism. Maternal hypothyroidism can impact both maternal and fetal health outcomes.
The document discusses thyroid disease in pregnancy. It describes the physiological changes in thyroid function during pregnancy, including increases in thyroid binding globulin and thyroid hormone levels. It covers the signs, symptoms, risks and treatment of both hyperthyroidism and hypothyroidism in pregnancy. For hyperthyroidism, the most common cause is Graves' disease. Risks include early pregnancy loss, fetal growth issues, and neonatal hyperthyroidism. Treatment involves antithyroid medications. For hypothyroidism, the most common causes are Hashimoto's thyroiditis and iodine deficiency. Risks include infertility, miscarriage, and impaired neurodevelopment. Treatment is levothyroxine supplementation.
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
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.
hyperthyroidism, thyrotoxicosis, grave disease, thyroid storm, pregnancy, high risk pregnancy, pregnancy complications, management of thyrotoxicosis and thyroid storm in pregnancy
This document discusses thyroid disease in pregnancy. It begins by outlining the anatomy and physiology of the thyroid gland and how thyroid function changes during pregnancy. It then discusses specific thyroid disorders that can occur during pregnancy, including hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), and subclinical hypothyroidism. For each condition, it describes the potential maternal and fetal effects, diagnostic criteria, and treatment recommendations. The document provides detailed information on evaluating and managing thyroid disease to optimize outcomes for both the mother and baby.
Hypothyroid Disorders in Obs & Gynae – Case based approach – Part -1 Lifecare Centre
Hypothyroid Disorders in Obs & Gynae – Case based approach – Part -1
Moderator - Dr Meenakshi Sharma
& Dr Puja Dewan
Panelist
Dr Dipti Nabh
Dr Richa Singhal
Dr Manju Sharma
Dr Deepa Gupta
Dr Renu Chawla
Dr Anita Agarwal
This document discusses thyroid disorders in pregnancy. It notes that thyroid disorders are common in pregnancy, affecting 1-2% of pregnancies with overt disease and 3-5% with subclinical disease. Thyroid screening and treatment in pregnancy can help improve outcomes for both mother and baby, though guidelines vary on who and when to screen. The document reviews thyroid changes in pregnancy, screening recommendations, treatment of hypothyroidism and hyperthyroidism, and complications like postpartum thyroid dysfunction.
Thyroid disorders are common in pregnancy . This is potential treatable cause of bad obstetric history .Hypothyroidism and hyperthyroidism both should be screened for clinically as well as by laboratory tests .
Due to availability of Thyroid testing ,it is more easily diagnosed and Treated.
Hypothyroid mother if not adequately treated ,there is poor mental development of the baby.
Due to awareness more and more diagnosis is made .There should be universal screening for thyroidal illness in pregnancy .
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
This document provides an overview of thyroid function and disorders during pregnancy. It discusses how the thyroid gland and thyroid function tests change normally during pregnancy. It also covers hyperthyroidism and hypothyroidism in pregnancy, including their effects on the fetus and neonate. Key points include that both hyperthyroidism and hypothyroidism can lead to adverse pregnancy outcomes if not properly treated, and maternal thyroid antibodies can affect the fetal thyroid gland. Precise diagnosis and treatment of thyroid disorders is important for maternal and fetal health.
My talk on Thyroid and Infertility in Jabalpur in Feb 2019. I have summarised the available evidence until 2019 in an easy to use flowchart and slides. It would be very useful for practicing Endocrinologists, Physicians and Obs-gyn.
Maternal thyroid physiology is modulated during pregnancy by increases in hCG, urinary iodide excretion, and thyroxine-binding globulin. Thyroid disorders complicating pregnancy include hyperthyroidism, hypothyroidism, and postpartum thyroiditis. Hyperthyroidism is treated during pregnancy with antithyroid medications to maintain normal thyroid hormone levels. Hypothyroidism requires increasing levothyroxine doses during pregnancy. Postpartum thyroiditis involves transient hyperthyroid and hypothyroid phases due to thyroid autoimmunity after delivery.
Hypothyroidism can impact fertility through several mechanisms. It disrupts the hypothalamic-pituitary-ovarian axis, leading to issues with ovulation and corpus luteum function. The prevalence of hypothyroidism among women of reproductive age is 2-4%. Autoimmune thyroid disease is also associated with infertility, endometriosis, and polycystic ovary syndrome. Screening for thyroid function and autoimmunity should be part of an infertility workup, as treatment of hypothyroidism or autoimmune disease may improve fertility and pregnancy outcomes.
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.
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.
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
The document discusses hypothyroidism, including its causes, signs and symptoms, diagnosis, and treatment. Some key points:
- Primary hypothyroidism is caused by failure of the thyroid gland and accounts for 99% of cases. Secondary hypothyroidism is caused by pituitary failure.
- Hashimoto's thyroiditis is the most common cause of hypothyroidism in iodine-sufficient areas. It is an autoimmune disorder more common in women.
- Diagnosis is based on elevated TSH and low free T4 levels. Treatment involves daily levothyroxine replacement therapy with dosages adjusted based on follow up TSH levels.
Lecture 6. Endocrine diseases and pregnancy (1).pdftotohaamzaa
The document discusses several key points regarding endocrine diseases and pregnancy:
1) The thyroid gland has important functions in maintaining pregnancy, including increased T4 requirements by the mother and fetus' dependence on maternal hormones in early pregnancy.
2) Physiological changes include suppression of TSH and increases in thyroid hormones and binding proteins, maintaining normal free levels.
3) Iodine deficiency is a major cause of thyroid issues worldwide, and intake of 250 μg/day is recommended for pregnant women.
4) Hypothyroidism occurs in 1% of pregnancies and requires thyroxine treatment. Thyrotoxicosis also requires medication management to prevent complications.
Thyroid disorders are common in pregnancy and can impact both mother and baby if not properly managed. Hypothyroidism is defined differently in pregnancy compared to non-pregnant women, with lower TSH thresholds indicating the need for treatment. Universal screening for thyroid dysfunction is recommended given many cases could be missed with high-risk screening alone. Treatment of hypothyroidism requires increasing the thyroxine dose throughout pregnancy and monitoring thyroid levels regularly. Positive thyroid antibodies also increase risks even in euthyroid women, so treatment may be needed in these cases as well. Close monitoring and management of thyroid function is important for optimizing outcomes in both mother and baby.
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
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.
hyperthyroidism, thyrotoxicosis, grave disease, thyroid storm, pregnancy, high risk pregnancy, pregnancy complications, management of thyrotoxicosis and thyroid storm in pregnancy
This document discusses thyroid disease in pregnancy. It begins by outlining the anatomy and physiology of the thyroid gland and how thyroid function changes during pregnancy. It then discusses specific thyroid disorders that can occur during pregnancy, including hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), and subclinical hypothyroidism. For each condition, it describes the potential maternal and fetal effects, diagnostic criteria, and treatment recommendations. The document provides detailed information on evaluating and managing thyroid disease to optimize outcomes for both the mother and baby.
Hypothyroid Disorders in Obs & Gynae – Case based approach – Part -1 Lifecare Centre
Hypothyroid Disorders in Obs & Gynae – Case based approach – Part -1
Moderator - Dr Meenakshi Sharma
& Dr Puja Dewan
Panelist
Dr Dipti Nabh
Dr Richa Singhal
Dr Manju Sharma
Dr Deepa Gupta
Dr Renu Chawla
Dr Anita Agarwal
This document discusses thyroid disorders in pregnancy. It notes that thyroid disorders are common in pregnancy, affecting 1-2% of pregnancies with overt disease and 3-5% with subclinical disease. Thyroid screening and treatment in pregnancy can help improve outcomes for both mother and baby, though guidelines vary on who and when to screen. The document reviews thyroid changes in pregnancy, screening recommendations, treatment of hypothyroidism and hyperthyroidism, and complications like postpartum thyroid dysfunction.
Thyroid disorders are common in pregnancy . This is potential treatable cause of bad obstetric history .Hypothyroidism and hyperthyroidism both should be screened for clinically as well as by laboratory tests .
Due to availability of Thyroid testing ,it is more easily diagnosed and Treated.
Hypothyroid mother if not adequately treated ,there is poor mental development of the baby.
Due to awareness more and more diagnosis is made .There should be universal screening for thyroidal illness in pregnancy .
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
This document provides an overview of thyroid function and disorders during pregnancy. It discusses how the thyroid gland and thyroid function tests change normally during pregnancy. It also covers hyperthyroidism and hypothyroidism in pregnancy, including their effects on the fetus and neonate. Key points include that both hyperthyroidism and hypothyroidism can lead to adverse pregnancy outcomes if not properly treated, and maternal thyroid antibodies can affect the fetal thyroid gland. Precise diagnosis and treatment of thyroid disorders is important for maternal and fetal health.
My talk on Thyroid and Infertility in Jabalpur in Feb 2019. I have summarised the available evidence until 2019 in an easy to use flowchart and slides. It would be very useful for practicing Endocrinologists, Physicians and Obs-gyn.
Maternal thyroid physiology is modulated during pregnancy by increases in hCG, urinary iodide excretion, and thyroxine-binding globulin. Thyroid disorders complicating pregnancy include hyperthyroidism, hypothyroidism, and postpartum thyroiditis. Hyperthyroidism is treated during pregnancy with antithyroid medications to maintain normal thyroid hormone levels. Hypothyroidism requires increasing levothyroxine doses during pregnancy. Postpartum thyroiditis involves transient hyperthyroid and hypothyroid phases due to thyroid autoimmunity after delivery.
Hypothyroidism can impact fertility through several mechanisms. It disrupts the hypothalamic-pituitary-ovarian axis, leading to issues with ovulation and corpus luteum function. The prevalence of hypothyroidism among women of reproductive age is 2-4%. Autoimmune thyroid disease is also associated with infertility, endometriosis, and polycystic ovary syndrome. Screening for thyroid function and autoimmunity should be part of an infertility workup, as treatment of hypothyroidism or autoimmune disease may improve fertility and pregnancy outcomes.
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.
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.
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
The document discusses hypothyroidism, including its causes, signs and symptoms, diagnosis, and treatment. Some key points:
- Primary hypothyroidism is caused by failure of the thyroid gland and accounts for 99% of cases. Secondary hypothyroidism is caused by pituitary failure.
- Hashimoto's thyroiditis is the most common cause of hypothyroidism in iodine-sufficient areas. It is an autoimmune disorder more common in women.
- Diagnosis is based on elevated TSH and low free T4 levels. Treatment involves daily levothyroxine replacement therapy with dosages adjusted based on follow up TSH levels.
Lecture 6. Endocrine diseases and pregnancy (1).pdftotohaamzaa
The document discusses several key points regarding endocrine diseases and pregnancy:
1) The thyroid gland has important functions in maintaining pregnancy, including increased T4 requirements by the mother and fetus' dependence on maternal hormones in early pregnancy.
2) Physiological changes include suppression of TSH and increases in thyroid hormones and binding proteins, maintaining normal free levels.
3) Iodine deficiency is a major cause of thyroid issues worldwide, and intake of 250 μg/day is recommended for pregnant women.
4) Hypothyroidism occurs in 1% of pregnancies and requires thyroxine treatment. Thyrotoxicosis also requires medication management to prevent complications.
Thyroid disorders are common in pregnancy and can impact both mother and baby if not properly managed. Hypothyroidism is defined differently in pregnancy compared to non-pregnant women, with lower TSH thresholds indicating the need for treatment. Universal screening for thyroid dysfunction is recommended given many cases could be missed with high-risk screening alone. Treatment of hypothyroidism requires increasing the thyroxine dose throughout pregnancy and monitoring thyroid levels regularly. Positive thyroid antibodies also increase risks even in euthyroid women, so treatment may be needed in these cases as well. Close monitoring and management of thyroid function is important for optimizing outcomes in both mother and baby.
Thyroid disorders are common in pregnancy and can impact both mother and baby if not properly managed. Hypothyroidism is defined differently in pregnancy compared to non-pregnant women, with lower TSH thresholds indicating the need for treatment. Universal screening for thyroid dysfunction is recommended given many cases could be missed with high-risk screening alone. Treatment of hypothyroidism requires increasing the thyroxine dose throughout pregnancy and monitoring thyroid levels regularly. Positive thyroid antibodies also increase risks even in euthyroid women, so treatment may be needed in these cases as well. Close monitoring and management of thyroid function is important for optimizing outcomes in both mother and baby.
1) Hypothyroidism in pregnancy can be caused by iodine deficiency, Hashimoto's thyroiditis, or other rare causes. It affects both mother and fetus.
2) For pregnant women, routine thyroid screening is controversial but may be recommended for those with risk factors. Hypothyroidism symptoms are similar to normal pregnancy symptoms.
3) Untreated hypothyroidism in pregnancy poses risks to both mother and fetus, including complications of pregnancy, cognitive impairments, and cretinism in the fetus. Treatment is with levothyroxine supplementation.
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
The document discusses the effects of pregnancy on thyroid physiology and function. It notes that pregnancy causes increases in thyroid binding globulins, plasma volume, hCG levels, and iodine requirements, all of which impact thyroid hormone levels. It also discusses the prevalence and causes of hypothyroidism in pregnancy, signs and symptoms, effects on maternal and fetal outcomes, and treatment recommendations including levothyroxine dosage optimization during pregnancy.
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
Thyroid disorders are common in pregnancy and can impact both mother and baby if not properly managed. Hyperthyroidism, hypothyroidism, and postpartum thyroid disease are the main thyroid conditions seen. Treatment involves medication like antithyroid drugs, levothyroxine, and beta blockers with careful monitoring of thyroid levels throughout pregnancy. Screening high-risk women and optimizing thyroid function is important for achieving good pregnancy outcomes.
THYROID DISORDERS IN PREGNANCY LAST.pptxrohiljain11
This document discusses thyroid disorders in pregnancy. It notes that thyroid function changes significantly during pregnancy, with increases in thyroid-binding globulin and human chorionic gonadotropin stimulating the thyroid. Both hypothyroidism and hyperthyroidism can cause complications if not properly managed. The document outlines diagnostic criteria and treatment guidelines for hypothyroidism and hyperthyroidism in each trimester, including dose adjustments and monitoring of levothyroxine treatment or use of antithyroid medications. Postpartum thyroiditis and fetal monitoring are also discussed.
This document discusses congenital hypothyroidism, including:
1. It is a preventable cause of mental retardation that occurs in 1 in 3000-4000 live births worldwide and 1 in 2500-2800 in India.
2. The most common cause is thyroid dysgenesis, which accounts for 75-80% of cases.
3. Newborn screening programs allow for early detection and treatment to prevent morbidity, particularly neurodevelopmental disabilities.
This document discusses tips about hypothyroidism in reproduction and pregnancy from recent guidelines by ACOG and ATA. It notes that thyroid disorders are common in young women and pregnancy, and that maternal and fetal thyroid function are closely related. Untreated hypothyroidism can lead to adverse pregnancy outcomes. Thyroid autoantibodies are associated with increased rates of early pregnancy loss. The document discusses thyroid physiology and how the thyroid gland and hormone levels change during pregnancy to meet increased demands. It also discusses iodine status, nutrition, and recommendations for iodine intake during pregnancy and lactation. The relationship between thyroid autoantibodies and pregnancy complications in euthyroid women is also summarized.
This document discusses thyroid disorders in newborns. It covers thyroid physiology in the fetus and newborn, causes of congenital hypothyroidism including thyroid dysgenesis and dyshormonogenesis, clinical features of hypothyroidism, and methods for screening and diagnosis of congenital hypothyroidism in newborns. It also addresses transient hypothyroidism, sick euthyroid syndrome, and the importance of newborn screening to detect congenital hypothyroidism.
Congenital hypothyroidism is inadequate thyroid hormone production in newborns. It occurs in 1 in 2500-4000 live births worldwide and is the most common preventable cause of mental retardation. Screening for congenital hypothyroidism involves measuring TSH levels in cord blood and recalling infants with elevated or borderline-low T4 levels for treatment and monitoring. Lifelong thyroid hormone replacement therapy if needed to ensure normal growth, development, and cognitive function. Early detection and treatment allows for normal development outcomes.
The thyroid gland is located in the anterior neck and consists of two lobes connected by an isthmus. It receives blood supply from the superior and inferior thyroid arteries and drains into the internal jugular and brachiocephalic veins. The thyroid synthesizes the hormones T3 and T4 through a process involving trapping of iodine, production of thyroglobulin, iodination of thyroglobulin, and release of T3 and T4. Thyroid hormone synthesis is regulated by TSH from the pituitary gland. Thyroid hormones increase metabolism and have important roles in growth, brain development, heart function, and thermogenesis. Pregnancy increases the demand for thyroid hormones to support the mother
Detailed presentation on congenital hypothyroidism including physiology, pathophysiology, newborn screening, management and follow up (including Sri Lankan practice).
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.
1) Congenital hypothyroidism is the most common preventable cause of mental retardation and can be diagnosed through newborn screening programs that measure TSH levels.
2) It is classified as permanent or transient, with permanent CH caused by thyroid dysgenesis, defects in hormone synthesis, TSH resistance, or central hypothyroidism.
3) Transient CH has various causes including antithyroid drugs, iodine excess or deficiency, prematurity, or blocking antibodies; it typically resolves on its own.
Similar to THYROID DISORDER IN PREGNANCY -Kamal.pptx (20)
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2. • Most common endocrine disorder in pregnancy.
• 1-2% pregnant women.
• Pregnancy may modify course of thyroid
disease.
• Pregnancy outcome can depend on optimal
management of thyroid disorders.
7. PHYSIOLOGICAL CHANGES IN THYROID
GLAND IN PREGNANCY
• Throughout pregnancy there is increased demand of
thyroid hormone because pregnancy is the state of
increased BMR[20-25%] , increased oxygen
consumption by mother and baby.
• Size of the gland increases but any visible increase in
size must be considered pathological.
8. • Because of increased thyroid hormone
production, increased renal iodine excretion, and
fetal iodine requirements, dietary iodine
requirements are higher in pregnancy than they
are for nonpregnant adults.
• Normal levels of thyroid hormone are essential for
neuronal migration and myelination of the fetal
brain.
• Iodine deficiency is the leading cause of
preventable mental retardation worldwide
9. • Human Chorionic Gonadotropin - a glycoprotein
heterodimer -α-subunit (identical to that of TSH, LH,
and FSH) and a specific β-subunit, which has similarity
to TSH.
• Total T3 &T4 is increased in pregnancy only if the gland
is normal .
• All globulins increase in pregnancy including thyroid
binding & sex hormone binding globulin .
10.
11. • Spot urinary iodine values are used most frequently
for determination of iodine status in general
populations.
• Whose median urinary iodine concentrations are 50–150
mg/L are defined as mildly to moderately iodine
deficient.
• WHO recommends 250 µg/d for pregnant women and for
lactating women.
• Dietary Iodine sources-Iodised salt,Sea food , Eggs, meat
12. IMPORTANT
Pregnancy is a state of relative iodine deficiency
Increase Placental uptake & Fetal Transfer.
Increase maternal renal clearance
Placenta converts T4 to reverse T3
Normal iodine requirement
ATA(American Thyroid Association) 2017:
150mcg/day during planning of pregnancy.
220mcg/day during pregnancy
290mcg/day during lactation.
WHO:-
250mcg/day during pregnancy and lactation
Estrogen
Rise in serum TBG,Increase in total T4 & T3.
Free T4 & T3 unchanged.
13. FIVE FACTORS THATALTER THYROID FUNCTION
IN PREGNANCY:
1. The transient increase in hCG during the first trimester,
which stimulates the TSH-R.
2. The estrogen-induced rise in TBG during the first trimester,
which is sustained during pregnancy.
3. Alterations in the immune system, leading to the onset,
exacerbation, or amelioration of an underlying
autoimmune thyroid disease.
4. Increased thyroid hormone metabolism by the placenta.
5. Increased urinary iodide excretion, which can cause
impaired thyroid hormone production in areas of
marginal iodine sufficiency.
14. EFFECTS OF PREGNANCY ON THYROID
PHYSIOLOGY
Physiologic Change Thyroid-Related Consequences
↑ Serum thyroxine-binding globulin ↑ Total T4 and T3; ↑ T4 production
↑ Plasma volume ↑ T4 and T3 pool size; ↑ T4
production; ↑ cardiac output
D3 expression in placenta and (?) uterus ↑ T4 production
First trimester ↑ in hCG ↑ Free T4; ↓ basal thyrotropin; ↑ T4
production
↑ Renal I- clearance ↑ Iodine requirements
↑ T4 production; fetal T4 synthesis during
second and third trimesters
↑ Oxygen consumption by fetoplacental
unit, gravid uterus, and mother
↑ Basal metabolic rate; ↑ cardiac
output
16. FETAL THYROID PHYSIOLOGY
Develops from 5th week .
Functions by 10 th week (T4 detected in blood)
Till 12 weeks fetus totally dependent on mother
Fetal thyroid distinct entity - post 12 weeks
Association between fetal and maternal hormone levels
TRH and iodine cross placenta freely
Less permeable to T3, T4 and TSH
Iodine deficiency – cretinism in neonates
Excessive iodine ingestion by mother – fetal iodine
induced hypothyroidism
Dr Shashwat Jani.
99099 44160.
18. Past history of thyroid disease or thyroid
lobectomy or postpartum thyroiditis
TSH > 3 mIU/ L
Family history of thyroid disease
Goitre
Thyroid antibodies (when known)
Symptoms or clinical signs suggestive of thyroid under
function or over function, including anaemia, elevated
cholesterol and hyponatraemia
Type 1 diabetes
Other autoimmune disorders
Infertility
Previous therapeutic head and neck irradiation
History of miscarriage or preterm delivery
27, 2012
19. Consensus : Indian Guideline on the Management of
Maternal Thyroid disorders
ALL PREGNANT
FEMALES SHOULD BE
SCREENED AT 1ST
ANTENATAL VISIT BY
MEASURING TSH
LEVEL.
15
20. THYROID EVALUATION IN NORMAL
PREGNANCY
Recommendation Indication
TSH and FT4
Screening
Interpretation should be trimester specific
TPO-Ab and Tg-Ab Presence of AITD
Ultrasound Advisable when nodular disease is suggested by
clinical examination
Usual recommendation for thyroid evaluation in normal pregnancy.
16
21. THYROID FUNCTION TESTS
IN PREGNANCY
Reference range
used for nonpregnant
population
First trimester Second trimester Third trimester
FT4 (pmol/L)
9–26
(0.7–2.02 ng/dL)
10–16
(0.78–1.25 ng/dL)
9–15.5
(0.70–1.3 ng/dL)
8–14.5
(0.62–1.13 ng/dL)
FT3 (pmol/L)
2.60–5.7
(0.2–0.44 ng/dL)
3–7
(0.23–0.55 ng/dL)
3–5.5
(0.23–0.43 ng/dL)
2.5–5.5
(0.2–0.43 ng/dL)
TSH (mu/L) 0.3–4.2
0.1–2.5 0.2–3.0
0.3–3.0
23. HYPOTHYROIDISM IN PREGNANCY
• Most common thyroid disorder in pregnancy is maternal
hypothyroidism
• In Western countries:
– Overt hypothyroidism occurs in 0.3% to 0.5% of pregnancies
– Subclinical hypothyroidism occurs in 2% to 3% of
pregnancies.
• Sahu et al study, 2009
– Subclinical hypothyroidism among pregnant women is 6.47%
– Overt hypothyroidism is 4.58%
– Progression from subclinical hypothyroidism to overt
hypothyroidism was seen in 3% to 29% of women with
autoimmunity
Epidemiology
24. HYPOTHYROIDISM IN PREGNANCY:
TYPES
• Elevated serum TSH and
subnormal FT4
• Symptomatic thyroid hormone
deficiency
Overt
hypothyroidism
• Elevated serum TSH and normal
FT4
• Biochemical thyroid hormone
deficiency
Subclinical
hypothyroidism
25. • Overt hypothyroidism – TSH 2.5-10
Low FT4
TSH≥ 10 mIU/ L
• Subclinical hypothyroidism –TSH 2.5-10 &
Normal FT4
• Isolated hypothyroxinemia – Normal TSH &
Low F T4
26. SHOULD EVERY ANTENATAL PT. WITH SUBCLINICAL
HYPOTHYROIDISM ( TSH>2.5 MIU/L) BE TREATED?
• For a TSH value >10.0 mIU/l, L-thyroxine
supplementation is mandatory. For those with a TSH
<2.5 mIU/l during first trimester, no further
investigations are needed.
• A FT4 estimation is indicated for patients with a
TSH of 2.5-10 mIU/l.
• A normal FT4 should ideally elicit a thyroid
antibody test, with therapy being initiated in all
antibody-positive patients.
27. • Treat all patients with overt hypothyroidism
(TSH > 10 mIU/l; TSH > 2.5 mIU/l with low
FT4); and all subclinically hypothyroid
patients with antibody positivity (TSH > 2.5
mIU/l, TAb+)
• Isolated hypothyroxinemia-Need not be
treated
28. MATERNAL HYPOTHYROIDISM :
AETIOLOGY
• Inadequate treatment of a woman with pre-existing hypothyroidism
• Overtreatment of a hyperthyroid woman with antithyroid
medications
• In iodine sufficient areas, the most common cause: Hashimoto’s
thyroiditis, an autoimmune disorder
• Treatment of hyperthyroidism using radioactive ablation or surgery
• Thyroid tumour surgery
31. TSH MONITORING
• During pregnancy –
Every 4 weeks until 16-20 weeks gestation.
At once between 26-32 weeks gestation
• After delivery –
Stop or titrate down levothyroxine .
Decrease dose by 30%(diagnosed in pregnancy)
Prepregnancy dose(hypothyroid before pregn.)
Retest TSH levels in 4-8 weeks
33. HYPOTHYROIDISM IN
PREGNANCY
•
•
•
• Patients with hypothyroidism should be treated with L-thyroxine
monotherapy.
L-thyroxine and L-triiodothyronine combinations should not be
administered to pregnant women or those planning pregnancy
Maternal serum TSH and total FT4 should be monitored every 4
weeks during the first half of pregnancy and at least once between
26 and 32 weeks gestation and L-thyroxine dosages adjusted as
indicated.
Patients with hypothyroidism being treated with L-thyroxine
who are pregnant, the goal TSH during the second trimester should
be less than 3 mIU/L and during the third trimester should be less
than 3.5 mIU/L.
34. THYROXINE TREATMENT FOR HYPOTHYROIDISM
IN PREGNANCY
• Preconception: Optimise therapy in patients with pre-
existing disease
• Pregnancy confirmed: Increase dose by 30% to 50% of
preconception dose
• Target levels of TSH:
– < 2.5 mIU/L in the first trimester
– < 3 mIU/L in later pregnancy
• After delivery: Reduce dose to preconception dose
• Assess thyroid function at 6 weeks postpartum
• Higher dose for postablative and postsurgical
hypothyroidism
35. THYROXIN TREATMENT FOR
HYPOTHYROIDISM IN
PREGNANCY
Average increment in L-Thyroxine dosage in women without residual
functional thyroid tissue depends on the initial elevation of serum TSH
Serum TSH elevation Augmented dose of L-Thyroxine
5–10 mIU/L 25–50 mcg/d
10 and 20 mIU/L 50–75 mcg/d
>20 mIU/L 75–100 mcg/d
First trimester TSH Start L-Thyroxine
2.5–5 mIU/L 50 mcg/d
5.0–8.0 mIU/L 75 mcg/d
>8 mIU/L 100 mcg/d
48
36. TSH FT4
Low TSH
Normal FT4
Goitre High TSH
Normal FT4
Physiological
suppression in 1st
trimester
Rpt. At 8 weeks
HYPOTHYROIDISM PATHWAY
High TSH
LowFT4>2.5
Yes No
Repeat
TSH FT4
at 6 wks
Euthyroid
followup
SubclinicalHypothyoidism
Check antimicrosomal anti TPO
Positive Negative
Role of post partum
Baby at higher risk of hypothyroidism
Standard FU