Hipertirodismo y Embarazo

Dra. Kelly Belen OrtizResidente Medicina Interna Universidad del Norte - HUN

HIPOTALAMO

HIPOFISIS

TIROIDEST4/T3

TRH

TSH

FISIOLOGIA TIROIDEA Y EMBARAZO

Estrogenos: > union hormonas tiroideas a TBG: Disminucion de Hormona tiroidea libre: estimulando Eje Hipotalamo Hipofisis Tiroides.

Incremento en el metabolismo tiroideo periferico: Segundo y tercer trimestre, secundario a la Deidodinasa 2 y 3 de la placenta.

hCG y TSH: Subunidad alfa identica, lo que estimula la liberacion de T3 y T4. Por retroalimentacion, se disminuye la TSH en la semana 8- 14.

DIAGNOSTICO

Valores TSH

T3/T4 Ajustado: 1.5 >.

T3i/T4i:Referencia según trimestre.

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

SCREENING TIROIDEO

PRESENTACION CLINICA

Manifestaciones Clinicas: Falla en gano de peso, Intolerancia al calor, sudor excesivo.

GESTACION

Hipertiroidismo

Gestacional

Supresion de la TSH

/hCG

Asx, primer

trimestre.

No Mxs

Enfermedad de

Graves

Antiroideos

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

HIPERTIROIDISMO Y EMBARAZO

MEDICAMENTOS

TIANOMIDAS: Propiltiouracilo, Metimazol y Carbimazol.

Beta Bloqueadores: Propanolol

CONSIDERACIONES

Todos los antitiroideos cruzan la barrera placentaria y lactancia: Hipotiroidismo fetal.

Utilizar la dosis menor para alcanzar rangos seguros maternos.

Tianomidas: Agranulocitosis

Metimazol: Malformaciones fetales

- Diagnosis and Management of Thyroid Disease in Pregnancy. Obstet Gynecol Clin N Am 37 (2010) 173–193- Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

INDICACIONES QUIRURGICAS

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

Tiroidectomia

Gestacion

Contraindicacion relativa

2do Trimestre

No Rta /No uso manejo

medico.

ABLACION CON YODO RADIOACTIVO

I 131: Contraindicado durante la gestacion.

No embarazarse 4-6 meses Postratamiento.

- Thyroid Emergencies. Med Clin N Am 96 (2012) 385–403.- Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

TORMENTA TIROIDEA

Exacerbacion aguda del hipertiroidismo.

Fiebre, taquicardia, alteraciones neurologicas.

Desencadenantes: Preeclampsia, cirugias, parto, infecciones.

Diagnosis and Management of Thyroid Disease in Pregnancy. Obstet Gynecol Clin N Am 37 (2010) 173–193

Thyroid Emergencies. Med Clin N Am 96 (2012) 385–403.

TRATAMIENTO

- Thyroid Emergencies. Med Clin N Am 96 (2012) 385–403.- Diagnosis and Management of Thyroid Disease in Pregnancy. Obstet Gynecol Clin N Am 37 (2010) 173–193

Disminuir la produccion y liberacion de T3/T4.

Disminuir los efectos perifericos de la T4 y T3

Manejo de la descompensacion sistemica y desencadenante

Diagnosis and Management of Thyroid Disease in Pregnancy. Obstet Gynecol Clin N Am 37 (2010) 173–193

- Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocrine practice vol 17 no. 3 may/june 2011

Vista desde la habitación de Fernando Borrego.Las Terrazas – Pinar Del Rio