Maternal-Fetal Thyroid Pathology

by Carlo Raj, MD

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    In this discussion, we’ll take a look at the interaction between the mother and the foetus and what may then happen when there is lack of proper thyroid functioning between the two symbiotic relationships. Maternal thyroid changes during pregnancy. Major alterations in the thyroid system during pregnancy include the following. Because of the estrogen, there will be an increase in total binding globulin. That increase in total binding globulin is then going to remove or more accurately bind the free T4. You will then increase the bound type of T4 which then increases the total. When the total T4 increases, remember that the free is going to then communicate with the hypothalamal pituitary axis and therefore making sure that the free is always available in the mother so that the foetus is properly developing. This is all perfectly normal during pregnancy with thyroid functioning. Also, as you can imagine because now, the hypothalamus, pituitary and the thyroid is increasing its production to normal levels of free there will also be increased demand for iodine. Results from an increase in iodide clearance by the kidney due to increased GFR that is also noted in pregnancy and siphoning. Meaning to say, the channelling of the iodine from the mother to the foetus for proper thyroid creation. The thyroid gland can increase in size during pregnancy called Pregnancy Induced Goiter, perfectly normal especially though in a patient from, let’s say, a developing country in which there is already iodine deficiency… that’s problematic. We’re going to walk through this graph in great detail. Let’s first dissect the graph like we’ve done with every single one to clearly understand as to what we’re trying to compare. On the X-axis would be the weeks of gestation… 10, 20, 30, 40… takes us to all three trimesters....

    About the Lecture

    The lecture Maternal-Fetal Thyroid Pathology by Carlo Raj, MD is from the course Thyroid Gland Disorders.

    Included Quiz Questions

    1. Development of cold nodules
    2. Increased TBG
    3. Increased T4 but total free T4 remains stable
    4. Pregnancy-induced goiter
    5. Slight decrease in TSH in first trimester
    1. TBG production is increased
    2. Estrogen decreases TSH levels
    3. Iodide levels increase, binding T4
    4. HCG stimulates TSH receptors, increasing T4 production
    5. T4 production decreases in first trimester, increasing to euthyroid levels in second trimester
    1. Decreased platelet count
    2. Decreased PVR in first trimester
    3. Increased CO in first trimester
    4. Increased plasma volume
    5. Increased heart rate
    1. End of the first trimester
    2. Beginning of second trimester
    3. End of second trimester
    4. Beginning of third trimester
    5. Just before birth
    1. Gestational diabetes
    2. Anemia
    3. Pre-eclampsia
    4. Postpartum hemorrhage
    5. Placental abnormalities

    Author of lecture Maternal-Fetal Thyroid Pathology

     Carlo Raj, MD

    Carlo Raj, MD

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