Hyperthyroidism Graves Disease

■ Thyrotoxicosis complicates 1 in 2,000 pregnancies.

■ Graves' disease is the most common cause of thyrotoxicosis in pregnancy.

■ Treatment is propylthiouricil or methimazole or surgery. Radioactive iodine is contraindicated in pregnancy.

Thyroid Storm

Thyroid storm is a major risk. Precipitating factors are infection, labor, and C-section.

Treatment

■ Sodium iodide

■ Parathyroid hormone (PTH)

■ Dexamethasone

25% mortality rate Complications

■ 1% risk of neonatal thyrotoxicosis

■ Fetal goiter/hypothyroid, usually from PTU

■ Preterm delivery

■ Preeclampsia

■ Preterm delivery

Hypothyroidism

Subclinical hypothyroidism is more common than overt hypothyroidism, and often goes unnoticed. Diagnosed by elevated TSH.

Postpartum Thyroiditis

Transient postpartum hypothyroidism or thyrotoxicosis associated with autoimmune thyroiditis is common:

■ Between 1 and 4 months postpartum, 4% of all women develop transient thyrotoxicosis.

■ Between 4 and 8 months postpartum, 2 to 5% of all women develop hy-pothyroidism.

Sheehan Syndrome

Pituitary ischemia and necrosis associated with obstetrical blood loss leading to hypopituitarism. Patients do not lactate postpartum due to low prolactin.

In normal pregnancy, total T3 and T4 are elevated but free thyroxine levels do not change.

Propylthiouracil (PTU) is the drug of choice over methimazole for treating thyrotoxicosis in pregnancy.

Overt hypothyroidism is often associated with infertility.

In women with type 1 DM, 25% develop postpartum thyroid dysfunction.

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