thyroid dysfunction and pregnancy

1. THYROID
DYSFUNCTION
AND PREGNANCY
DR SALINI MANDAL B.G.
ASST PROFESSOR
DEPT OF OBG
FMHMC

2. HYPERTHYROIDISM

3. OIs a set of disorders that involve
excess synthesis and secretion
of thyroid hormones by the
thyroid gland.

5. O Nervousness
O Anxiety
O Increased perspiration
O Heat intolerance
O Hyperactivity
O Palpitations

6. O Tachycardia
O Systolic hypertension
O Warm, moist skin
O Smooth skin
O Stare
O Tremor
O Weight loss
O Muscle weakness

7. INCIDENCE
O 2 per 1000 pregnancies

8. COMPLICATIONS
MATERNAL
FETAL / NEONATAL

9. MATERNAL

10. MISCARRIAGE

11. O PRETERM DELIVERY
O PREECLAMPSIA
O CONGESTIVE CARDIAC FAILURE

12. PLACENTA ABRUPTIO

13. OTHYROID STORM (fever, fast
n irregular heart beat,
vomiting, diarrhoea)
OINFECTION

14. FETAL

15. OIUGR
OPREMATURITY
OSTILLBIRTH

16. OHYPERTHYROIDISM
OHYPOTHYROIDISM
OINCREASED MORBIDITY AND
MORTALITY

17. PATHOGENESIS

18. OTHYROID STIMULATING
ANTIBODIES  CROSSES THE
PLACENTA  PRODUCES
NEONATAL THYROTOXICOSIS
WITH INCREASED NEONATAL
DEATH.

19. INVESTIGATIONS

20. OTSH supressed.
OT3 and T4 elevated
OThyroid stimulating
immunoglobulins.

21. ORadioactive iodine uptake and scans
should not be done during pregnancy.
OIt will cross the placenta and damage
the fetal thyroid gland permanently.

22. Treatment…
OAntithyroid drug.
OCarbimazole is given orally with a
daily dose of 20 – 60 mg and
maintained at this dose until the
patient becomes euthyroid.
OLater progressively reduced the
dosage to 5 – 15 mg daily.

23. OPropylthiouracil is given at a daily
use of 300 – 450 mg and continued
till the patient becomes euthyroid,
later maintained to 50- 150 mg daily.

24. OSide effects:
OCarbimazole may be asso with aplasia
cutis of the neonate.
OBoth the drugs may cause fetal goitre
and hypothyroidism.

25. ODrugs are not contraindicated
during breast feeding provided the
dose is kept relatively low and close
monitoring of the neonatal thyroid
functions is carried out.
OCord blood should be taken for
clincial diagnosis

26. OThyroidectomy, when required to relief
the pressure symptoms can be done
safely in the second trimester with prior
biochemical control

27. Preconceptional counselling
O Adequate treatment should be instituted to
bring down the thyroid function profile to
normal.
O Radioactive iodine therapy should not be given
to patients wanting pregnancy within 1 yr
O If pregnancy occurs, termination should be
done

28. HYPOTHYROIDISM
AND
PREGNANCY

29. Either…
O First time diagnosis in pregnancy
O Hypothyroid women who either discontinue
thyroid therapy or who need larger doses in
pregnancy.
O Hyperthyroid women on excessive amounts of
antithyroid drugs.

30. OPrimary  related to thyroid
autoimmunity.
OMyxedema  rare  as it leads to
infertility.
OUntreated  early pregnancy wastage
of conceptus, prematurity, deficient
intellectual development of the child.

31. O Complications like :- preeclampsia,
anemia.
O Treatment:- TSH should be repeated at
interval of 6 – 8 weeks as there is
increased demand of thyroid hormone in
the second half of pregnancy.

32. Hyperthyroidism

33. Arsenicum iodatum
O Hyperthyroid.
O Thyroid: Goitre. Indurated gland.
O General: Warm or even very hot yet often
sensitive to cold or drafts.
O Better: Open air.
O Worse: Becoming heated in bed.
O Marked emaciation despite eating
ravenously.

34. Natrum mur
O Great weakness and weariness.
O Oversensitive to all sorts of influences.
O Hyperthyroidism.
O Great liability to take cold

35. Baryta carbonica
O Hyperthyroid,
O Thyroid: Huge swelling of gland.
O General: Appetite increased with
emaciation.
O Emaciation with large, pot-belly.

36. Zincum iod
O Zincum iodatum is suited to hyperthyroid
constitutions.
O Goitre.
O Cold sweat in umbilical region.

37. Kalium iodatum
O Hyperthyroid. Goitre.
O Thyroid: Diffusely enlarged.
O Thyroid enlarged and very sensitive to
touch.
O General: Aggravated by heat.

38. Lachesis mutus
O Hyperthyroid. Thyroiditis.
O Thyroid: Left-sided goitre.
O Tightness in throat; difficult swallowing.

39. Iodum
O Hyperthyroid. Goitre.
O Thyroid: Painful, enlarged thyroid.
O Right-sided goitre.
O Constriction in thyroid region.
O General: Hot. Intolerant of heat or warm
room.
O Better: Eating. Cold bathing. Violent
exertion.
O Emaciation despite huge appetite.

40. OARANEA IXOBOLA
OASARUM EUROPAEUM
OCALC FLUOR
OMAGNESIUM FLUOR
OTHALIUM METALLICUM
OSPONGIA
OBARYTA IOD
OLYCOPUS
OELATERIUM

41. O Fucus vesiculosus
O Ferrum iod
O Cactus
O Belladonna
O Aurum met
O Apis
O Thyroidinum

42. Hypothyroidism

43. Kali carb
O With soft pulse, coldness, general
depression, and very characteristic
stitches, which may be felt in any part of
the body, or in connection with any
affection.
O Pain in small spot on left side
Hypothyroidism.

44. Argentum nitricum
O Hypothyroidism.
O General: Hot. Averse to warm rooms.
O Better: Cool or open air.

45. O Corticotropinum
O Alumina
O Conium
O Gelsemium
O Graphites
O Lycopodium
O Sepia