THYROID DISEASE

 Testing
for hypothyroidism using TSH
measurements before or early in pregnancy
may be warranted in symptomatic women
and in women with a personal or family
history of thyroid disease.

 With
use of this case-finding approach, about
30% of pregnant women with mild
hypothyroidism remain undiagnosed, leading
some to recommend universal screening.
 Disease TSH FT4 FT3 Management

Propylthiouracil (PTU) 50 to 150 mg orally TID

Hyperthyroidis depending on severity (Bahn, 2011)/ 300 or 450 mg of
Low High High PTU daily in three divided doses for pregnant women
m
(Parkland)

Subclinical consideration for treatment of subclinical

hyperthyroidism in individuals 65 years or older and in
Hyperthyroidis Low Normal Normal postmenopausal women to improve cardiovascular
m health and bone mineral density.

Levothyroxine 1 to 2 μg/kg/day or approximately 100

μg daily, Surveillance: TSH levels measured at 4- to 6
Hypothyroidism High Low Low week interval. Thyroxine dose is adjusted by 25- to 50-
mcg increments until TSH values become normal

Isolated
NO interventional data have yet been published
Hypothyroxine Normal Low — that demonstrate beneficial effects of LT4 therapy
mia

Low (early) Supportive therapy, Management of dehydration,

Transient
Normal — — Anti-thyroid drugs: not recommended, Beta blockers
Thyrotoxicosis may be considered
(mid)
 HYPERTHYROIDISM
Management
Methimazole and Propylthiouracil crosses the
 Both
placenta

 Methimazole — fetal aplasia cutis.

 Propylthiouracil— liver failure.

 Some experts recommend:

 Propylthiouracil in the first trimester

 Methimazole thereafter

 Radioiodine should not be used during pregnancy

 HYPOTHYROIDISM
Management

 Goalof therapy for hypothyroidism: maintain

the serum TSH in the normal range.

 Thyroxine is the drug of choice.

 Thyroid Storm

 Rare

 Occasionally iatrogenic disorder

 Multisystem involvement

 Highmortality rate if not immediately

recognized and treated aggressively
Burch-Wartofsky Point Scale for
Diagnosis of Thyroid Storm

Source: 2016 American Thyroid

Association Guidelines
 BWPS score

 >45 points – consistent with thyroid storm

 25-44 points – impending thyroid storm

 <25 points – thyroid storm unlikely

 BWPS 25-44: sound clinical judgement to use

aggressive therapy to avoid overtreatment
and drug toxicity
inhibit thyroidal release of T3 and T4

block peripheral conversion of T4 to T3

Source: Williams Obstetrics 25th edition

 When treating Thyroid storm REMEMBER
“5Bs”

 Block synthesis (antithyroid drugs)

 Block release (iodine)

 BlockT4 to T3 conversion (high dose PTU,

Propranolol, corticosteroid,, rarely
amiodarone)

B blocker (Propanolol)

 Blockenterohepatic circulation
(cholestyramine)