hipertirodismo y embarazo
TRANSCRIPT
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