Thyroid Disorders in Pregnancy

Krajewski, Dorota A.; Burman, Kenneth D.

doi:10.1016/j.ecl.2011.08.004

Cited by 18 publications

(13 citation statements)

References 121 publications

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“…A large plasma volume and thus an altered distribution of thyroid hormone, increased thyroid hormone metabolism, increased renal clearance of iodide, and higher levels of hepatic production of thyroxine-binding globulin (TBG) in the hyperestrogenic state of pregnancy are responsible for higher thyroxine requirements in pregnancy. [3] It is very important to remember that biochemical thyroid function should be free thyroid hormone, as total hormone will mislead showing more than normal value when the patient is euthyroid.…”

Section: Introductionmentioning

confidence: 99%

Thyroid disorders in pregnancy

Ramprasad¹,

Bhattacharyya²,

Bhattacharyya³

2012

Indian J Endocr Metab

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Section: Introductionmentioning

confidence: 99%

Thyroid disorders in pregnancy

Ramprasad¹,

Bhattacharyya²,

Bhattacharyya³

2012

Indian J Endocr Metab

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“…Maternal complications include pre-eclampsia, congestive heart failure, placental abruption and caesarean delivery. 3 Foetal risks of maternal thyrotoxicosis include spontaneous abortion, premature labour and low birth weight, stillbirth and congenital abnormalities. 3 …”

Section: Discussionmentioning

confidence: 99%

Thyroid storm causing placental abruption: Cardiovascular and management complications for the Intensivist

Lane

Tarvade

2014

Journal of the Intensive Care Society

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Thyroid storm is a rare and serious complication of pregnancy which can lead to spontaneous abortion, preterm delivery, preeclampsia and cardiac failure. It is also associated with high maternal and foetal mortality if not diagnosed and managed promptly. The diagnosis of thyroid storm in pregnancy can pose significant challenges due to its presentation being similar to other pregnancy-related complications. We present a patient who developed thyroid storm at 29 weeks of pregnancy, which resulted in pre-term delivery, cardiac failure and thyroidectomy. We discuss the treatment of thyroid storm in pregnancy, the decision making involved in proceeding to thyroidectomy or to use radio-iodine, and foetal thyroid status in thyrotoxicosis. KeywordsThyroid storm, placental abruption, thyroidectomy, stress-induced cardiomyopathy, radioiodine Case reportA 29-year-old pregnant woman presented with symptoms of lower back pain and vaginal bleeding. She was 29 weeks pregnant (gravida 2, para 2) with no previous antenatal history. Her past medical history included iron-deficiency anaemia, hypertension and a familial history of type II diabetes mellitus. On examination, the patient's vital signs were as follows: temperature 37.4 C; heart rate 140 beats/min; blood pressure 140/80 mmHg; respiratory rate 40 breaths/ min; SpO 2 94% while breathing air. Vaginal examination revealed blood-stained mucus in the vagina and a dilated cervix of 2 cm. Her initial chest radiograph (CXR) showed some opacification at both the left and right base ( Figure 1); however, in view of her high body mass index (>30), and sudden increase in her tachypnoea, a computed tomography pulmonary angiogram (CTPA) was arranged to investigate for potential pulmonary emboli. While the CTPA was being arranged, her cardiotocography (CTG) monitoring became 'non-reassuring' and emergency caesarean section was undertaken. This took place under general anaesthesia given her respiratory distress.On induction of anaesthesia with sodium thiopental and suxamethonium, she developed hypertension of 220/120 mmHg and atrial fibrillation (AF) with a rapid ventricular response of 180 beats/min. This was treated by increasing the depth of anaesthesia, intravenous amiodarone 300 mg and magnesium sulphate 20 mmol, following which she reverted to sinus rhythm at a rate of 130 beats/min. She required an FiO 2 of 0.55 and Positive end-expiratory pressure (PEEP) 10 cm H 2 O to maintain adequate oxygenation, and her compliance appeared reasonable with manual ventilation not being difficult. She was found to have a placental abruption, though the operative blood loss was estimated at 1.5 L which was less than expected. Thick meconium was noted at the time of delivery. She received transfusion of six units of packed red blood cells, four units of fresh-frozen plasma, and two units of cryoprecipitate guided by her estimated blood loss and the pre-operative full blood count and coagulation studies: Hb 100 g/L; white cell count (WCC) 28.7

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“…mester (27). After the first trimester, the fetal thyroid takes over as the main source of thyroid hormone.…”

Section: Invited Reviewmentioning

confidence: 99%

An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist

Beynon

Pinneri

2016

Academic Forensic Pathology

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The thyroid gland is a butterfly-shaped organ situated in the anterior neck whose functions have system-wide effects. Thyroid diseases represent some of the most commonly encountered endocrine disorders and therefore are commonly encountered at the time of autopsy. Knowing how the gland functions and the effects it may have on vital organs is important when determining the cause of death and significant contributory conditions. Endocrine-related deaths may be anatomically subtle, therefore histologic examination, review of medical records, and selected postmortem testing must be performed to correctly identify and document their presence. For this reason, it is recommended that pathologists consider regularly examining the thyroid gland histologically, particularly on decedents where no apparent anatomic cause of death is identified after the autopsy. This article provides an in-depth review of the thyroid gland, thyroid hormones, and thyroid diseases, including potential thyroid-related deaths and incidental autopsy findings.

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Thyroid Disorders in Pregnancy

Cited by 18 publications

References 121 publications

Thyroid disorders in pregnancy

Thyroid disorders in pregnancy

Thyroid storm causing placental abruption: Cardiovascular and management complications for the Intensivist

An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist

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