Thyroid Strategies for Primary Care-The Evaluation and Management of Hyperthyroidism in Pregnancy

Video Transcription

Video Summary

In this video, Dr. Chrysoula Dosiou discusses the evaluation and management of hyperthyroidism in pregnancy. She begins by explaining the changes in thyroid physiology that occur during pregnancy, including the rise in human chorionic gonadotropin (HCG) and the increase in thyroid-binding globulin (TBG) levels. Dr. Dosiou then discusses the prevalence and differential diagnosis of maternal hyperthyroidism, focusing primarily on Graves' disease. She highlights the importance of distinguishing between Graves' disease and gestational transient thyrotoxicosis, which typically presents in the first trimester. <br /><br />Dr. Dosiou then discusses the evaluation of hyperthyroidism in pregnancy, emphasizing the need for pregnancy-specific reference ranges for laboratory tests. She mentions the use of thyroid-stimulating immunoglobulin (TSI) and thyrotropin receptor antibodies (TRAB) to aid in the diagnosis of Graves' disease. <br /><br />Moving on to the management of hyperthyroidism in pregnancy, Dr. Dosiou discusses the use of antithyroid drugs, such as propylthiouracil (PTU) and methimazole. She notes that these drugs can cross the placenta and discusses the potential risks associated with their use. Dr. Dosiou also mentions the option of surgery for the treatment of hyperthyroidism, as well as the potential use of radioactive iodine prior to pregnancy. <br /><br />Finally, Dr. Dosiou addresses the monitoring and follow-up of pregnant women with hyperthyroidism, emphasizing the importance of close monitoring throughout pregnancy and postpartum. She also highlights the need to balance maternal and fetal risks when making treatment decisions.

Keywords

hyperthyroidism

pregnancy

thyroid physiology

Graves' disease

gestational transient thyrotoxicosis

thyroid-stimulating immunoglobulin

antithyroid drugs

surgery

radioactive iodine

monitoring