1. Hyperthyroidism During Pregnancy Overt hyperthyroidism Subclinical hyperthyroidism

2. The Most Common Cause of Hyperthyroidism Graves’ disease hCG mediated hyperthyroidism Hyper emesis gravidaraum Multiple pregnancies Trophoblastic disease

3. Changes in thyroid physiology TBG excess results in high serum total T4 concentrations (not free T4) High serum hCG results in transient subclinical or overt hyperthyroidism

4. Pregnancy complications Spontaneous abortion Premature labor Low birth weight Stillbirth Preeclampsia Heat failure Thyroid storm

5. Diagnosis TSH < 0.1 or undetectable Free T4 Free T3 Total T4 Total T3 TRAb

6. Treatment Indication Moderate to severe overt hyperthyroidism T4 or T3 > 1.5 times Thionamids + Betablockers Hypoglycemia IUGR Plasmapheresis Radioiodine First 2 weeks Spontaneous miscarriage 2 to 12 weeks Birth defects 12 to 14 weeks fetal thyroid ablation

7. Hypothyroidism During Pregnancy Overt hypothyroidism 0.3 - 0.5 Subclinical hypothyroidism 2 – 2.5

8. Pregnancy Complications Preeclampsia and gestational hypertention Placental abruption Nonreassuring fetal heart rate tracing Preterm delivery, including very preterm delivery Low birth weight Increased rate of cesarean section Perinatal morbidity and mortality Neuropsychological and cognitive impairment Postpartum hemorrhage

9. Diagnosis First trimester 0.1 < TSH < 2.5 Second trimester 0.2 < TSH < 3 T4 Third trimester 0.3 < TSH < 3 TPO in subclinical

10. The Universal Screening of Asymptomatic Pregnant Women for Thyroid Dysfunction YesNo or

11. ATA and ACOG recommend targeted case : From an area of known modarate to severe iodine insufficiency Have a family or personal history of thyroid disease Have thyroid peroxidase antibodies Type 1 diabetes History of preterm delivery or miscarriage History of head or neck radiation BMI ≥ 40 Infertility Age > 30 years

12. Treatment Indication Overt moderate to severe 1.6 mcg/kg TSH < 10 1mcg/kg Subclinical Per existing hypothyroidism TSH < 1.2

13. Positive TPO Complications Preterm birth Fetal loss Perinatal mortality Large-for-gestational-age infants Subclinical hypothyroidism Post partum thyroiditis

14. Does Positive TPO Need Treatment?