Chapter-
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1
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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
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HYPOTHYROIDISM DURING
PREGNANCY
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DEFINITIO
N
Primary maternal hypothyroidism is defined as the
presence of elevated TSH levels during pregnancy.
Hypothyroidism can be overt (OH) or subclinical (SCH).
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• 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.
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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
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EFFECT
On On
• Preterm births
• Result
Motherin miscarriages Baby
• Intrauterine growth
(in early pregnancy)
restriction
• Recurrent pregnancy
• Intrauterine fetal demise
losses
• Respiratory distress
• Anaemia
• Increased perinatal mortality
• Pre-eclampsia
(PNM)
• Gestational diabetes
• In newborns,leads to
• Abruptio placentae
cognitive,neurological
• Postpartum hemorrhage 8
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.
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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.
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• 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).
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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.
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Risk Factors
• Women with a family history of
hypothyroidism
• Autoimmune thyroiditis
• More common in women with type I diabetes
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Treatment
Most patients recover simultaneously without
treatment. The hypothyroid state is more likely to be
treated. Postpartum depression is more common in
these women.
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HYPERTHYROIDISM/
THYROTOXICOSIS
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DEFINITIO
N
It is the over secretion of the thyroid hormone due to
increased metabolic rate.
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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.
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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.
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SIGN & SYMPTOMS
• Thyrotoxicosis (nervousness, hyperexcitability, and
irritability)
• Exopthalamus, i.e., bulging eyes
• Palpitation
• Tachycardia
• Failure to weight gain
• Heat intolerance
• Emotional lability
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DIAGNOSIS
• 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.
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EFFECT ON
PREGNANCY
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MANAGEMENT
Medical
The mainstay of the treatment is the use of
antithyroid
drugs, such as
• Propylthiouracil (PTU)
• Carbimazole
• Methimazole (MM).
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Surgical
When required to relieve the pressure symptoms,
thyroidectomy can be safely performed in the second
trimester with prior biochemical control.
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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.
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Care in the
• Reassure the mother.
Hospital
• 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.
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• 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. 26
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