Subject:           Thyroid Disease

 

Screening/Diagnosis: Thyroid disease in pregnancy may be associated with spontaneous abortion, growth disorders, fetal thyroid gland enlargement or tachycardia, increased incidence of stillbirths, preeclampsia, and placental abruption.

 

Recommendation:

 

Women with symptoms of thyroid disease should be screened.

 

Hypothyroidism

Symptoms: Paresthesia, gross myxedema, low body temperature, periorbital edema, large tongue, hoarse voice, intolerance to cold, lethargy, brittle nails, and dry skin.  Thyroid gland may be enlarged.

 

Hyperthyroidism

Symptoms:  Nervousness, palpitation, increased appetite, heat tolerance, fatigue, weight loss, increased sweating.  Tachycardia, goiter, tremor onycholysis, hyperkinetic reflexes, dyspnea on exertion.

 

Lab Tests:

            In Hypothyroidism:  Total T4 and Free T4 are moderately decreased.

            TSH is elevated.

            In Hyperthyroidism:  TSH is decreased and free T$ is elevated.

 

Patients diagnosed with hypo or hyperthyroidism should be referred to High Risk OB Clinic for ongoing care.

 

 

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.