USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

OB TRIAD

Graves  Disease

Thyroid storm is a life-threatening hypermetabolic state presenting with
pyrexia, tachycardia, and severe dehydration. Management is propylthiouracil
(PTU), β-blocking agents, steroids, and iodine.

Graves' disease (most common kind of hyperthyroidism in pregnancy) is
mediated by autoimmune production of thyrotropin-receptor antibodies (TSHR-
Ab) that drives thyroid hormone production independent of thyrotropin (TSH).
TSHR-Ab can cross the placenta, potentially causing fetal hyperthyroidism.

Diagnosis. Diagnosis is confirmed by elevated free T 4 and TSHR-Ab, as well as
low TSH in the presence of clinical features described above.

↓   TSH level

↑   free    T 4     level

TSHR-Ab

If  uncontrolled,   it  is  associated  with    increased   spontaneous abortions,

prematurity,    intrauterine    growth  retardation (IUGR), and perinatal   morbidity

and mortality.

If  controlled, pregnancy   outcome is  not altered.    Clinical    features    include

elevated    resting pulse,  thyromegaly,    exophthalmos,   inadequate  weight  gain    or

even    weight  loss,   and markedly    elevated    total   and free    T 4.