Approach to Thyroid and Parathyroid Disorders During Pregnancy: The Fetus is the Linchpin
Linda Anne Barbour, MSPH,MD
University of CO School of Medicine and Anschutz Medical Campus
Autoimmune Thyroid Disease in pregnancy is significantly increasing, and Hyperparathyroidism is the most common calcium disorder in pregnancy. It is of paramount importance to both mother and fetus for the endocrinologist to accurately diagnose both conditions given the marked influences of hCG, estrogen, and placental/breast PTH-rP, changes in thyroid and calcium metabolism, striking alterations in laboratory assessments, and the limitations of free assays. Even more critical is to understand when and how aggressively to treat these conditions and the major consequences to the fetus from over-treatment or under-treatment, the contraindication of T3 supplementation, and how the immune tolerance of pregnancy demands frequent medication adjustments. Distinguishing Graves’ from gestational thyrotoxicosis is key, as is differentiating rebound from Graves’ or postpartum thyroiditis, given Graves’ and Hashimoto’s commonly co-exist. Recognizing when medical management of thyroid/parathyroid disease is ineffective, and surgery is indicated, is also essential and will be covered in this session.