Hyperthyroidism During Pregnancy

• Overt hyperthyroidism

• Subclinical hyperthyroidism

The Most Common Cause of Hyperthyroidism

• Graves’ disease

• hCG mediated hyperthyroidism• Hyper emesis gravidaraum• Multiple pregnancies• Trophoblastic disease

Changes in thyroid physiology

• TBG excess results in high serum total T4

concentrations (not free T4)

• High serum hCG results in transient

subclinical or overt hyperthyroidism

Pregnancy complications

• Spontaneous abortion• Premature labor• Low birth weight• Stillbirth• Preeclampsia• Heat failure• Thyroid storm

Diagnosis

• TSH < 0.1 or undetectable • Free T4• Free T3• Total T4• Total T3• TRAb

Treatment

• Indication• Moderate to severe overt hyperthyroidism T4 or T3 > 1.5 times• Thionamids + Betablockers Hypoglycemia IUGR

• Plasmapheresis • Radioiodine First 2 weeks Spontaneous miscarriage2 to 12 weeks Birth defects12 to 14 weeks fetal thyroid ablation

Hypothyroidism During Pregnancy

• Overt hypothyroidism 0.3 - 0.5

• Subclinical hypothyroidism 2 – 2.5

Pregnancy Complications• Preeclampsia and gestational hypertention• Placental abruption• Nonreassuring fetal heart rate tracing• Preterm delivery, including very preterm delivery • Low birth weight• Increased rate of cesarean section• Perinatal morbidity and mortality• Neuropsychological and cognitive impairment• Postpartum hemorrhage

Diagnosis

• First trimester 0.1 < TSH < 2.5 • Second trimester 0.2 < TSH < 3 T4• Third trimester 0.3 < TSH < 3• TPO in subclinical

The Universal Screening of Asymptomatic Pregnant Women

for Thyroid Dysfunction

Yes Noor

• ATA and ACOG recommend targeted case :• From an area of known modarate to severe iodine

insufficiency• Have a family or personal history of thyroid

disease • Have thyroid peroxidase antibodies • Type 1 diabetes • History of preterm delivery or miscarriage• History of head or neck radiation • BMI ≥ 40• Infertility • Age > 30 years

Treatment

• Indication• Overt moderate to severe 1.6 mcg/kg• TSH < 10 1mcg/kg• Subclinical • Per existing hypothyroidism TSH < 1.2

Positive TPO Complications

• Preterm birth• Fetal loss• Perinatal mortality• Large-for-gestational-age infants• Subclinical hypothyroidism• Post partum thyroiditis

Does Positive TPO Need Treatment?