1 of 27

1

Chapter-6

2 of 27

2

Thyroid Diseases in Pregnancy

3 of 27

3

INTRODUCTION

After diabetes, thyroid disease is the most common endocrine problem encountered in pregnancy. Hence, an accurate diagnosis and treatment of the condition are essential. In thyroid dysfunction, mainly two problems occur:

1. Hypothyroidism.

2. Hyperthyroidism

4 of 27

4

An I’ll.

HYPOTHYROIDISM DURING PREGNANCY

5 of 27

5

DEFINITION

Primary maternal hypothyroidism is defined as the presence of elevated TSH levels during pregnancy.

Hypothyroidism can be overt (OH) or subclinical (SCH).

6 of 27

6

  • In overt hypothyroidism, serum TSH levels are elevated, and serum T4/free T4 (FT4) levels are low.
  • Serum TSH ≥10 mIU/L is taken as OH irrespective of FT4 levels
  • Subclinical Hypothyroidism: In SCH, the TSH level is elevated (≤10 mIU/L) with normal serum T4/FT4.

7 of 27

7

RISK FACTOR

  • Iodine insufficiency
  • Obesity
  • History of prior thyroid dysfunction
  • Symptoms of thyroid dysfunction
  • Autoimmune diseases
  • Recurrent miscarriages,
  • History of infertility
  • Use of amiodarone or lithium

8 of 27

8

​

EFFECT

On Mother

On Baby

  • Result in miscarriages (in early pregnancy)
  • Recurrent pregnancy losses
  • Anaemia
  • Pre-eclampsia
  • Gestational diabetes
  • Abruptio placentae
  • Postpartum hemorrhage
  • Preterm births
  • Intrauterine growth restriction
  • Intrauterine fetal demise
  • Respiratory distress
  • Increased perinatal mortality (PNM)
  • In newborns,leads to cognitive,neurological impairment

9 of 27

9

MANAGEMENT

  • The drug of choice for treatment is levothyroxine.
  • Levothyroxine sodium is available in the market as “tablets” in different strengths.
  • Levothyroxine is to be taken orally in the morning on an empty stomach; the patient should be asked not to take anything orally for at least half an hour after taking the medicine. The strength required for this is 25, 50, 75, and 100 μg.

10 of 27

10

Nursing Management

  • Proper care and psychological support.
  • The mother’s condition should be supervised in the antenatal period.
  • Room temperature should be maintained.
  • The mother should give a warm blanket to maintain the temperature.
  • If she feels cold, give her warm clothes to wear.

11 of 27

11

​

  • Explain to the relatives about the care of the patient.
  • Maintain the nutritional status of the mother.
  • Record vital signs regularly.
  • Record weight.
  • Record fetal heart sound (FHS).

12 of 27

12

Postpartum Thyroiditis

It usually presents 3–4 months after delivery and can be hypothyroidism or hyperthyroidism. It can also be a biphasic state with initial hyperthyroidism and subsequent hypothyroidism.

13 of 27

13

Risk Factors

• Women with a family history of hypothyroidism

• Autoimmune thyroiditis

• More common in women with type I diabetes

14 of 27

14

Treatment

Most patients recover simultaneously without treatment. The hypothyroid state is more likely to be treated. Postpartum depression is more common in these women.

15 of 27

15

HYPERTHYROIDISM/THYROTOXICOSIS

16 of 27

16

DEFINITION

It is the over secretion of the thyroid hormone due to increased metabolic rate.

17 of 27

17

Pregnancy and Hyperthyroidism

​

Thyrotoxicosis usually improves in pregnancy similar to other autoimmune condition. This is due to relative immunosuppression in pregnancy, which leads to lower antibody levels. Hence, there is a lower need for antithyroid treatment.

18 of 27

18

ETIOLOGY

  • Physiological changes during pregnancy, such as an increase in cardiac output, oxygen consumption, and heat production
  • Autoimmune hyperthyroidism
  • Toxic nodular goiter
  • Trophoblastic diseases
  • Subacute thyroiditis.

19 of 27

19

SIGN & SYMPTOMS

  • Thyrotoxicosis (nervousness, hyperexcitability, and irritability)
  • Exopthalamus, i.e., bulging eyes
  • Palpitation
  • Tachycardia
  • Failure to weight gain
  • Heat intolerance
  • Emotional lability

20 of 27

20

  • Raised free T3, T4 along with a low TSH.
  • Rarely, there may be an abnormally high T3 called T3 toxicosis.
  • Antithyroglobulin antimicrosomal antibodies and thyroid-stimulating immunoglobulin should be measured.
  • A thyroid examination showed an enlarged thyroid gland.

DIAGNOSIS

21 of 27

21

EFFECT ON PREGNANCY

22 of 27

22

MANAGEMENT

Medical

The mainstay of the treatment is the use of antithyroid

drugs, such as

  • Propylthiouracil (PTU)
  • Carbimazole
  • Methimazole (MM).

23 of 27

23

Surgical

When required to relieve the pressure symptoms, thyroidectomy can be safely performed in the second trimester with prior biochemical control.

24 of 27

24

Nursing Management

​

1. Preconception Counseling

  • Considering the hazards during pregnancy
  • Adequate treatment should be instituted to restore the thyroid function profile to normal.
  • Oral pills are to be withheld.
  • Radioactive treatment should not be given to patients wanting pregnancy within 1 year.

25 of 27

25

Care in the Hospital

  • Reassure the mother.
  • Patients suffering from hyperthyroidism find room temperature uncomfortable, so always try to maintain a relaxed, comfortable environment.
  • Give the mother fresh, cool bedding and clothes.
  • Give a cool bath, if permitted.
  • Explain to the family members about the care of thepatient.

26 of 27

26

  • Give the mother a well-balanced diet.
  • The diet should be given frequently as due to the disease process, appetite is increased.
  • Give her a high-protein diet.
  • The mealtime atmosphere should be calm, quiet, and pleasing to aid digestion.
  • Record vital signs, especially pulse and BP.
  • Do not leave the patient alone.
  • Check the fetal heart sounds regularly and record and report appropriately.
  • Avoid stress and excitement.

27 of 27

27