Thyroid diseases in pregnancy PPT made By Sonal Patel

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

6. Two Disorder
Hypothyroidism
Hyperthyroidism

7. Hypothyroidism

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.

10. Causes
Primary
hypothyroidism
(thyroid gland)
Secondary
hypothyroidism
(pituitary)

11. Primary hypothyroidism
(thyroid gland)
1. Endemic iodine
deficiency
2. Radioiodine therapy
3. Thyroidectomy

12. Secondary hypothyroidism
(pituitary)
Lymphocytic
hypophysitis
Hypophysectomy
Painless
inflammation
with
progressive
enlargement
of the
thyroid gland

13. Signs

14. Symptoms
Fatigue
Constipation
Cold
intolerance
Muscle
cramps
Insomnia
Weight gain
Hair loss

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).

18. Frank
Hypothyroidism
Subclinical
Hypothyroidism
Hypothyroid
Coma
Management

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

23. Nursing Management

24. Nursing Management
71
mcg
Swiss
chard
3.96 mcg
76
mcg
71
mcg
71
mcg
19
mcg
150
mcg
185
mcg
23
mcg
50
mcg
cardamom

25. Nursing Management

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)

31. Symptoms
Nausea/Vomiting
Weight loss
Nervousness
Heat
intolerance
Insomnia,
Anxiety
Breathlessness
Diaphoresis,
Fatigue

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

35. Management
Medical
SurgicalNursing

36. Management
Medical
• Control of Symptoms.
• Discontinue once euthyroid.
Medical
• Control of Hyperthyroidism.
• Thionamides (carbimazole, methimazole,
propylthiouracil)
• Rarely: Potassium iodine, Potassium
perchlorate, lithium.

37. Surgery Management
Subtotal
thyroidectomy
Thyroidectomy

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.

39. Nursing Management

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.