1. Thyroid disorder in pregnancy.ppt

Thyroid disorders in pregnancy

1. Thyroid disorder in Thyroid disorder in
pregnancypregnancy
Ahmed abdulwahabAhmed abdulwahab

2. introductionintroduction
Pregnancy has significant impact on the normal Pregnancy has significant impact on the normal
maternal physiologymaternal physiology. .
There is increase in maternal production of There is increase in maternal production of
thyroid- binding globulin by the liver thyroid- binding globulin by the liver
because of estrogen stimulationbecause of estrogen stimulation. .
There is increase in total T4 and T3 but there is There is increase in total T4 and T3 but there is
no significant change in free thyroid no significant change in free thyroid
hormone FT4 FT3hormone FT4 FT3. .
The renal clearance of iodine increase in The renal clearance of iodine increase in
bregnancybregnancy. .

3. Maternal hyperthyroidismMaternal hyperthyroidism
It occurs I in 500 pregnanciesIt occurs I in 500 pregnancies. .
Majority are diagnosed before pregnancyMajority are diagnosed before pregnancy. .
Graves disease comprises 90% it is an Graves disease comprises 90% it is an
autoimmune disease with circulating thyroid autoimmune disease with circulating thyroid
stimulating antibodiesstimulating antibodies. .
Rarer causesRarer causes. .
Toxic nodulesToxic nodules..
Hashimotos thyroiditisHashimotos thyroiditis. .
Multiple nodular goiterMultiple nodular goiter

4. Clinical presentationClinical presentation
Maternal tachycardiaMaternal tachycardia..
Weight lossWeight loss..
Heat intoleranceHeat intolerance. .
Heart murmursHeart murmurs. .
Clinical diagnosis is difficult since all these Clinical diagnosis is difficult since all these
symptoms are well recognized in normal symptoms are well recognized in normal
pregnancypregnancy. .
Thyroid function test will confirm the Thyroid function test will confirm the
diagnosisdiagnosis . .

5. Uncontrolled hyperthyroidism will causeUncontrolled hyperthyroidism will cause..
Maternal cardiac arrhythmias like AFMaternal cardiac arrhythmias like AF. .
Vomiting ,diarrhoea ,abdominal pain and Vomiting ,diarrhoea ,abdominal pain and
psychosispsychosis. .
In case of autoimmune disease thyroid In case of autoimmune disease thyroid
stimulating antibodies will cross the stimulating antibodies will cross the
placenta and cause fetal goiterplacenta and cause fetal goiter

6. Other complicationsOther complications..
Fetal growth restrictionsFetal growth restrictions. .
StillbirthStillbirth. .
Fetal tachycardiaFetal tachycardia.. ..
Premature laborPremature labor..

7. treatmenttreatment
Drug therapy to maintain FT4 and FT3 in Drug therapy to maintain FT4 and FT3 in
the normal rangethe normal range. .
Treatment is usually medical with Treatment is usually medical with
carbimazole , the lowest dose should be carbimazole , the lowest dose should be
used as high dose may cross the placenta used as high dose may cross the placenta
that will leads to hypothyroidismthat will leads to hypothyroidism
Occasionally beta- blockers and surgical Occasionally beta- blockers and surgical
treatment can be undertakentreatment can be undertaken
Radioactive iodine is contraindicatedRadioactive iodine is contraindicated..

8. Maternal hypothyroidismMaternal hypothyroidism
The commonest worldwide cause is iodine The commonest worldwide cause is iodine
deficiencydeficiency
Maternal iodine deficiency is associated Maternal iodine deficiency is associated
with the development of cretinism in the with the development of cretinism in the
newborn due to congenital newborn due to congenital
hypothyroidism other cause is over hypothyroidism other cause is over
treating hyperthyroidismtreating hyperthyroidism. .
Women treated with radioactive iodine will Women treated with radioactive iodine will
frequently use thyroxine supplementsfrequently use thyroxine supplements

9. SymptomsSymptoms. .
BradycardiaBradycardia. .
Weight gainWeight gain. .
Heat intoleranceHeat intolerance. .
Hair lossHair loss . .
ConstipationConstipation..
All is confusing with normal pregnancy All is confusing with normal pregnancy
symptomssymptoms
Treatment by thyroxine replacement therapyTreatment by thyroxine replacement therapy..