THYROID DISEASES IN PREGNANCY: HYPO AND HYPER

Thyroid disease in pregnancy

1. Subhatharshni Mohan Hospital Putrajaya Thyroid Disease in Pregnancy

2. INTRODUCTION You can give a brief description of the topic you want to talk about here. For example, if you want to talk about Mercury, you can say that it’s the smallest planet in the entire Solar System

3. Physiological Changes in Pregnancy

4. Physiological Changes in Pregnancy Thyroid gland increases in size by 10% (20% to 40% in areas of iodine deficiency) Production of the thyroid hormones increases by nearly 50% 50% increase in the daily iodine requirement hCG stimulates TH secretion, often decreasing TSH concentrations, especially in early pregnancy

5. Significance & Impact Hypothyroidism: premature birth, low birth weight, pregnancy loss, and lower offspring IQ Hyperthyroidism miscarriages, preterm delivery, hypertension, heart failure, and thyroid storm Fetal transfer of TRAb fetal hyperthyroidism intrauterine growth retardation, stillbirth, low birth weight ATD Teratogenic foetal hypothyroidism as a result of transfer of ATD

6. Maternal and Fetal Complications Conditions Maternal Fetal Hypothyroidism A nemia Gestational Hypertension P re-eclampsia I ncreased placental weight PPH CCF Congenital malformation Cretinism Pre-term delivery LBW Spontaneous abortion Fetal distress Neuromotor-cognitive Hyperthyroidism Heart failure Placental abruption Pre-eclampsia GDM Accelerated HPT Thyroid storm Goiter IUGR LBW SGA IUD Pre-term Delivery Thyroid dysfunction

7. WHO TO SCREEN? Family hx Hx of hyper/hypothyroid disease/ PPT/ thyroid lobectomy Goiter Presence of thyroid antibodies Symptoms: anemia, elevated cholesterol, hyponatremia T1DM/ other autoimmune disorders Infertility

8. WHO TO SCREEN? Previous head or neck irradiation Hx of miscarriage/pre-term delivery Age ≥ 30 Morbid obesity Lithium or amiodarone use Recent iodinated radiologic contrast Residing in areas of mod to severe iodine deficiency ≥ 2 prior pregnancies

9. WHAT TO SCREEN TSH FT4 TPOAb and TgAb *

10. WHen TO SCREEN

11. HYPOTHYROIDSM

12. maternal hypothyroidism is defined as a TSH concentration elevated beyond the upper limit of the pregnancy-specific reference range Each institution should establish their own pregnancy specific reference intervals for each trimester of pregnancy using the local population   CPG recommends a TSH upper reference limit of 4 mIU /L Overt maternal hypothyroidism: decreased serum fT4 below the lower limit Subclinical Hypothyroidism: isolated high TSH with fT4 within the pregnancy-specific reference range Isolated hypothyroxinemia: Low FT4 concentrations despite normal TSH concentrations

13. OH should be treated with LT4   SCHypo LT4 treatment should be considered in the following situations to reduce the risk of miscarriage and preterm delivery: negative TPOAb : LT4 is recommended if TSH is >10 mIU /L LT4 may be considered if TSH is above the pregnancy specific reference range or 4.0 mIU /L positive TPOAb : LT4 is recommended if TSH is above the pregnancy specific reference range or 4.0 mIU /L LT4 may be considered if TSH is >2.5 mIU /L

14. Prevalence and Causes 0.3% to 4.8% Onset of the disease in pregnancy is rare Most Common: Hashimoto’s thyroiditis Others: previous surgery, radioiodine ablation, congenital hypothyroidism, lymphocytic hypophysitis High pre-pregnancy BMI: significant risk factor

15. 7.1.3 Is Maternal OH/ SCHypo Associated With Adverse Maternal/ Foetal Outcomes? 7.1.4 What Is The Impact Of TPO Ab Positivity on Euthyroid Women Or Women With Subclinical Hypothyroidism In Pregnancy? 7.1.5 Does Treatment With Levothyroxine (LT4) Improve Adverse Outcomes Associated With Maternal Overt/Subclinical Hypothyroidism? 7.1.6 Does Treatment With LT4 Improve Adverse Outcomes Associated With TPO Ab Positivity

16. LT4 & Monitoring Week 4-6 increase in LT4 requirement occurs LT4 dosage increased by 30%–50% upon conception Week 16-20 gradually increases Week 28-Delivery Plateaus higher % - post ablative hypothyroidism lower % - autoimmune hypothyroidism TFT- every 4 weeks from conception-mid gestation At least 1x during the middle of the 3rd trimester

17. TSH Goals Before conception -1 st Trimester: no more than 2.5 mIU /L 2 nd - 3 rd trimester- 3.0 mIU /L or below reverted to the normal reference range for non-pregnant women after delivery

18. HYPERTHYROIDSM

19. Gestational Transient Thyrotoxicosis vs autoimmune

20. REVIEW OF SYSTEMS Despite being red, Mars is a cold place full of iron oxide dust Venus has a beautiful name and is the second planet from the Sun Jupiter is a gas giant and the biggest planet in the Solar System Earth is the third planet from the Sun and the only one with life Venus Jupiter Mars Earth

21. PHYSICAL EXAMINATION Venus is the second planet from the Sun and is hotter than Mercury Jupiter is a gas giant and the biggest planet in the entire Solar System Percussion Inspection Palpation Despite being red, Mars is a cold place and is full of iron oxide dust

22. AWESOME WORDS

23. A PICTURE ALWAYS REINFORCES THE CONCEPT

24. PATIENT MEDICAL HISTORY Venus has a beautiful name and is the second planet from the Sun Despite being red, Mars is a cold place full of iron oxide dust Mercury is the closest planet from the Sun and the smallest one Age 30 Gender Male Diseases None Location Spain Venus Mars Mercury 20XX 20XX 20XX

25. DISCUSSION “Earth is the third planet and the only one that harbors life” Laura Patterson “Saturn is composed mostly of hydrogen and helium” John James “Venus has a beautiful name and is the second planet” Monique Nelson “Jupiter is the biggest planet in the Solar System” Christina Doe

26. DISCUSSION SUMMARY Mercury is the closest planet to the Sun and the smallest one in the Solar System—it’s only a bit larger than the Moon. The planet’s name has nothing to do with the liquid metal, since Mercury was named after a Roman god

27. Despite being red, Mars is actually a cold place Neptune is the farthest planet from the Sun DIAGNOSIS Mercury is the closest planet to the Sun Venus is the second planet from the Sun Jupiter is the biggest planet of them all Saturn is composed of hydrogen and helium Venus Saturn Mars Neptune Mercury Jupiter

28. TREATMENT Venus has a beautiful name and is the second planet from the Sun. It’s hot and has a poisonous atmosphere Mercury is the closest planet to the Sun and the smallest one in the Solar System—it’s only a bit larger than the Moon Mercury Venus

29. Is Jupiter's rotation period Earths is the Sun’s mass 9Hh 55M 23S 333,000

30. A PICTURE ALWAYS REINFORCES THE CONCEPT Images reveal large amounts of data, so remember: use an image instead of a long text. Your audience will appreciate it

31. 150 , 000 Big numbers catch your audience’s attention

32. CONTRAINDICATIONS & INDICATIONS You can describe the treatment indication here You can describe the treatment indication here You can describe the treatment indication here You can describe the treatment indication here You can describe the treatment contraindication here You can describe the treatment contraindication here You can describe the treatment contraindication here You can describe the treatment contraindication here CONTRAINDICATIONS INDICATIONS

33. POST- PREVENTION Despite being red, Mars is actually a cold place Earth Earth is the planet where we all live Mars Jupiter Jupiter is the biggest planet in the Solar System Saturn Saturn is a gas giant and has several rings

34. CASE TIMELINE Jupiter It’s the biggest planet of them all Mercury It’s the closest planet to the Sun Earth Earth is the planet where we all live Venus Venus is even hotter than Mercury 01 02 03 04

35. HIGHER INCIDENCE Jupiter is the biggest planet in the Solar System Jupiter Mercury is the smallest planet in the Solar System Mercury 25% 75%

36. FINDINGS Follow the link in the graph to modify its data and then paste the new one here. For more info, click here Neptune is far away from us Neptune Mars Mars is actually a cold place 70% 65% Earth is where we all live Earth Jupiter Jupiter is the biggest planet 75% 85%

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42. Did you like the resources on this template? Get them for free at our other websites: Photos Woman going through abortion process Gynecologist performing ultrasound consultation Medium shot pregnant woman at work Vectors Pregnancy symptoms illustration Hand drawn flat design thyroid infographic I Hand drawn flat design thyroid infographic so now I can use Icons Icon Pack: Pregnancy | Filled RESOURCES

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