••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^147
❍ How is thyroid storm treated?
(1) PTU 600 to 800 mg orally STAT, then 150 to 200 mg orally every 4 to 6 hours. Alternatively, methimazole
rectal suppositories may be used if oral administration is not possible
(2) 1 to 2 hours after PTU administration 2 to 5 drops of saturated solution of potassium iodide every 8 hours,
sodium iodide 0.5 to 1.0 g IV q8 h, Lugol solution, 8 drops q6h, or lithium carbonate, 300 mg po q6h.
(3) Dexamethasone, 2 mg IV or IM q6h × 4 doses
(4) Propranolol 20 to 80 mg orally q4 to 6 h or 1 to 2 mg IV q5 min for a total of 6 mg, then 1 to 10 mg IV
q4h. Alternatively reserpine, guanethidine, or diltiazem may be used if the patient has a history of severe
bronchospasm.
(5) Phenobarbital 30 to 60 mg orally q6 to 8 h for extreme restlessness
❍ Name some signs and symptoms of hypothyroidism.
Fatigue, constipation, cold intolerance, muscle cramps, hair loss, dry skin, prolonged relaxation phase of deep
tendon reflexes, carpal tunnel syndrome, weight gain in spite of decreased appetite, intellectual slowness, voice
changes, and insomnia. Untreated hypothyroidism may progress to myxedema coma.
❍ What neonatal condition is associated with iodine deficient hypothyroidism?
Congenital cretinism.
❍ What is the most common etiology of hypothyroidism in developed countries?
Hashimoto disease.
❍ What antibodies are associated with Hashimoto disease?
Thyroid antimicrosomal and antithyroglobulin antibodies.
❍ What laboratory values should be measured in pregnant women suspected to have thyroid disease?
TSH and free T4, or free thyroxine index (FTI).
❍ How often should the dose of levothyroxine be adjusted?
It takes 4 weeks for the effects of levothyroxine to be reflected in the TSH level, so doses should not be adjusted
more frequently than every 4 weeks.
❍ Is treatment of subclinical hypothyroidism of any benefit?
Studies have shown no benefit in IQ scores of children born to women with subclinical hypothyroidism that were
treated versus untreated. There is no recommendation to treat subclinical hypothyroidism in pregnancy.
❍ How should thyroid cancer be managed in pregnancy?
Surgery can often be delayed until after delivery due to the indolent course of most thyroid cancers and the risk of
preterm delivery due to surgery.