Cases of Thyroid of Disease & Pregnancy

• Discuss why screening thyroid function in pregnancy is controversial• Review subclinical hypothyroidism in pregnancy: when to Rx • Discuss whether TPOAb -positive euthyroid women benefit from thyroxine treatment in pregnancy• Discuss management of hypo- & hyperthyroidism in pregnancy, and know what is gestational hyperthyroidism• What is postpartum thyroiditis & how to manage it We will discuss 8 cases of thyroid disease & pregnancy:1. Routine screening vs targeted screening; which to recommend for detecting thyroid disease in pregnancy. 2. An asymptomatic pregnant woman with serum TSH level of 3 needs no treatment.3. When serum TSH is 4 or more LT4 therapy should be started.4. Elevated TSH has adverse consequences for fetus & the mother. Overt, as well as subclinical hypothyroidism, should be diagnosed early and treated. 5. A woman on thyroxine should increase her dose soon as she is pregnant.6. Hyperemesis gravidarum should be treated by rest and hydration; it seldom requires additional therapy.7. GD in early pregnancy needs PTU and later in pregnancy either PTU or MMI. These drugs are safe but should be used with caution in pregnant women.8. Postpartum thyroiditis is common and should be suspected in women with indeterminate symptoms soon after delivery.