HYPERTIROIDISM

IN PREGNANCY
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Hello!
Nandini Nur Annisa and Ridha Hayyu Nisa
COASS Fakultas Kedokteran Universitas Padjadjaran
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Pregnancy has a profound impact on EPIDMIOLOGY

the thyroid gland and thyroid function.
INTRODUCTION Globally hyperthyroidism happens ini
WHY? 0,05-3% in all pregnancies over the
• The gland increases 10%-40% in world and the most common cause
size during pregnancy is Graves' disease.
• Production of thyroxine (T4) and
triiodothyronine (T3) increases
by 50%. .
• The range of thyrotropin (TSH),
influenced by placental human
chorionic gonadotropin (hCG).

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 PHYSIOLOGICAL
CHANGES OF
THYROID
FUNCTION DURING
PREGNANCY
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Hormonal Changes

A normal pregnancy results in a number of important

physiological and hormonal changes that alter thyroid
function. Thyroid function tests change during
pregnancy due to the influence of two main hormones:
human chorionic gonadotropin (hCG) and estrogen.
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SIZE CHANGES

The thyroid gland can increase in size

during pregnancy (enlarged thyroid = goiter).
However, pregnancy-associated goiters occur
much more frequently in iodine-deficient areas
of the world.
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ETIOLOGY AND
PATHOGENESIS
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Overall, the most common cause (80-85%) of maternal

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hyperthyroidism during pregnancy is Graves’ disease
and occurs in 1 in 1500 pregnant patients

What is Grave’s Disease?

Graves’ disease is an autoimmune disease that leads to a
generalized overactivity of the entire thyroid gland. The
antibodies in Graves’ disease bind to receptors on the surface
of thyroid cells and stimulate those cells to overproduce and
release thyroid hormones. This results in an overactive thyroid
(hyperthyroidism).
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2 Very high levels of hCG, seen in severe forms of

morning sickness (hyperemesis gravidarum).
Why?
hCG can act like TSH and crank up the function of the
thyroid gland. Beta hCG can cause hyperthyroidism
because the molecular structure of these two hormones.
As it turns out, hCG and TSH are rather similar to each
other.
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Fetal and neonatal thyroid dysfunction

If antibodies do not decline they will cross the
PATO- placenta and stimulate the fetal thyroid, evidenced by
PHYSIOLOGY signs of fetal hyperthyroidism such as tachycardia,
intrauterine growth retardation, cardiac failure, and
the development of fetal goitre.

Pregnancy Outcome:
• Pre-eclampsia
• Heart failure
• Fetal loss
• Premature labour
• Low birthweight baby
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• Severe nausea
• Irregular or vomiting
SIGN AND heartbeat • Slight tremor
• Nervousness
SYMTOMPS

• Trouble sleeping
• Weight loss or
low weight gain for
Symptoms of hyperthyroidism may mimic those a typical pregnancy
of normal pregnancy, such as an increased
heart rate, sensitivity to hot temperatures, and
fatigue.
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Laboratory Test
• high levels of thyroid hormones,
History Taking T3 and T4 (the gold standard is
• Anxiety
DIAGNOSIS • Irritability or moodiness
using quilibrium dialysis coupled
• Nervousness, hyperactivity
with mass spectrometry)
• Sweating or sensitivity to • low level of thyroid stimulating
high temperatures hormone (TSH)
• Hand trembling (shaking)
• Hair loss

Radiologic Examination
•USG
Physical Examination
•Mass
•Heart rate : tachycardia
•Irregular heartbeat
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M
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1. Observe and evaluate by using ultrasound scans.THEN,

Fetal IF fetal hyperthyroidism is diagnosed, treatment involves
surveillance modulation of maternal antithyroid drugs.

IF fetal hypothyroidism has resulted from administration of

antithyroid drugs to the mother, this treatment should be
decreased or stopped and administration of intra-amniotic
thyroxine considered.

Early delivery may need to be considered in the case of fetal thyroid

dysfunction, depending on the gestation at diagnosis and the severity of
fetal symptoms.
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POSTPARTUM
PERIOD Breastfeeding!
Propylthiouracil and methimazole are secreted in human
milk, however, only limited quantities of propylthiouracil
and carbimazole are now known to be concentrated into
milk.
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Prognisis
GOOD IF TREATED PROMPTLY
THANK YOU