Journal Review in Endocrine Surgery: Thyroid and Parathyroid Disorders in Pregnancy

Jul 29, 2024

Guest

John Phay

Guest

Priya H. Dedhia

Guest

Vennila Padmanaban

Join surgical experts Dr. Vennila Padmanaban, a surgical oncology fellow, Dr. Priya H. Dedhia, an assistant professor specializing in endocrine surgery, and Dr. John Phay, a clinical professor of surgery. They delve into how pregnancy alters thyroid and parathyroid physiology and discuss the complexities of managing thyroid disorders during this critical time. Key topics include the risks of unmanaged hyperthyroidism, the importance of multidisciplinary care, and guidelines for surgery versus medical management during pregnancy. It's an insightful conversation for both patients and practitioners!

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ANECDOTE

Thyroid Disease Flares Affect Pregnancy

The team describes typical thyroid disease outcomes: flares of thyroiditis can alternate hyper- and hypothyroid phases during pregnancy.
They emphasize severe maternal hyperthyroidism risks including pregnancy loss, hypertension, prematurity, and fetal developmental issues.

INSIGHT

Pregnancy Alters Thyroid Physiology

Pregnancy changes thyroid size and hormone levels, so trimester-specific interpretation is required.
Beta-hCG and increased TBG raise T4/T3 and can confound thyroid testing in early pregnancy.

ADVICE

Antithyroid Drug Choices In Pregnancy

Avoid methimazole in pregnancy due to fetal toxicity; use the lowest effective PTU dose if needed.
Do not use radioactive iodine in pregnant patients and consult MFM or endocrinology for complex cases.

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Pregnancy leads to many physiologic changes, and thyroid and parathyroid disorders alter that physiology even more leading to complex laboratory interpretation and decision-making impacting both mother and fetus. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Vennila Padmanaban from The Ohio State University. Hear about normal and abnormal thyroid and parathyroid physiology and treatment of patients with thyroid cancer. The group discusses several articles focusing on current guidelines from the American Thyroid Association as well as other key studies.

Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Vennila Padmanaban, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Twitter handles:
Barbra Miller - @OSUEndosurgBSM
John Phay – @JohnPhayMD
Priya Dedhia – @priyaknows
Vennila Padmanaban - @vennilapadmanMD

Learning objectives:
1) Understand normal changes in thyroid and parathyroid physiology during pregnancy
2) Describe the impact of thyroid and parathyroid dysregulation on maternal and fetal health
3) Compare and contrast management of thyroid and parathyroid disorders during pregnancy vs. non-pregnancy
4) Recognize the importance of multidisciplinary care of patients with thyroid and parathyroid disorders

References:
1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. doi: 10.1089/thy.2016.0457.correx. PMID: 28056690
https://pubmed.ncbi.nlm.nih.gov/28056690/
2. Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus. 2024 Mar 5;16(3):e55544. doi: 10.7759/cureus.55544. PMID: 38576690; PMCID: PMC10993087
https://pubmed.ncbi.nlm.nih.gov/38576690/
3. Patel, Kepal N. MD; Yip, Linwah MD; Lubitz, Carrie C. MD, MPH; Grubbs, Elizabeth G. MD; Miller, Barbra S. MD; Shen, Wen MD; Angelos, Peter MD; Chen, Herbert MD; Doherty, Gerard M. MD; Fahey, Thomas J. III MD; Kebebew, Electron MD; Livolsi, Virginia A. MD; Perrier, Nancy D. MD; Sipos, Jennifer A. MD; Sosa, Julie A. MD; Steward, David MD; Tufano, Ralph P. MD; McHenry, Christopher R. MD; Carty, Sally E. MD. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery 271(3):p e21-e93, March 2020. DOI: 10.1097/SLA.0000000000003580
https://pubmed.ncbi.nlm.nih.gov/32079830/
4. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023 May 17;108(6):1505-1513. doi: 10.1210/clinem/dgac734. PMID: 36546344; PMCID: PMC10188304
https://pubmed.ncbi.nlm.nih.gov/36546344/
5. Eremkina A, Bibik E, Mirnaya S, Krupinova J, Gorbacheva A, Dobreva E, Mokrysheva N. Different treatment strategies in primary hyperparathyroidism during pregnancy. Endocrine. 2022 Sep;77(3):556-560. doi: 10.1007/s12020-022-03127-3. Epub 2022 Jul 12. PMID: 35821184
https://pubmed.ncbi.nlm.nih.gov/35821184/

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