Accurate method of estimating

thyroid function  compensates for

 GFR   Iodine by 50%

Free T4 conc. Thyroid Function Pregnanc
test THYROID DISEASE y
 Serum bound T3 and T4

Iodide (freely cross placenta)

Freely
Cross Placent <10 w  no iodine in
TSH-Ab (cause fetal thyroid al
thyroid
Transf 11 to 12 w  produce T4
Fetal Thyroid
T4 (important for neural Function
development in first trimester >12 w  Able to concentrate
Limit
before mature fetal thyroid) ed iodine, and Fetal TSH, T4,
TRH (low circ. levels, not and free T4  mature thyroid

TSH (DOES NOT CROSS) Do Not

Cross

Prematurity Complicati Maternal Hyperthyroidism Incidence 1 per 500

ons pregnancies
IUGR Graves’ disease (most)
Investigatio Treatment
Sympto
ns
Superimposed PET ms
Difficult (many S&S are
 Serum free T4 Propylthiouracil (PUT) &
Stillbirth present in normal euthyroid
Methimazole cross
pregnancies)
 Neonatal M&M  TSH levels placenta (can cause fetal Resting pulse > 100 bpm
hypothyroidism)  give (fails to slow with Valsalva
Precipitating minimal dose for within maneuver)
Thyroid Storm factors Radioactive iodine Rx Eye changes, Weight loss,
S&S Heat intolerance
Infection
Surgical Rx only if Medical fails
Hyperthermia Labor
Marked tachycardia Cesarean
Perspiration Noncompliance Maternal Hypothyroidism
Complicati
High output failure Investigati
Treatment on ons
Severe dehydration Spontaneous Abortion
 TSH levels (imp)
Propanolol
PET
Neonatal Sodium iodide Neonatal
Abruption
PTU
1% (due to TSH-Ab Congenital Hypothyroidism LBW/Stillbirth
Dexamethesone
Lasts 2 – 3 months Generalized Developmental Lower IQ (cretinism)
Fluid replacement
16% neonatal mortality Etiology: thyroid dysgenesis, inborn
Hypothermic
Fetal HR continently > Most common cause of neonatal goiter
Fetal goiter seen on US is maternal ingestion of iodideds
present in cough syrup