ABSTRACT
The most discriminatory features in pregnancy are weight loss, tremor, a persistent tachycardia, lid lag and exophthalmos. The latter feature indicates thyroid disease at some time rather than active thyrotoxicosis. Thyrotoxicosis may lead to sinus tachycardia, supraventricular tachycardia or atrial fibrillation. If poorly controlled, a thyroid crisis (storm) in the mother and heart failure may develop, particularly at the time of delivery. Carbimazole and propylthiouracil are the most commonly used anti-thyroid drugs in the United Kingdom. Most patients are initially treated with 15–40 mg carbimazole (150–400 mg PTU) for 4—6 weeks. Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease, although it usually presents after the childbearing years. Untreated hypocalcaemia in the mother increases the risk of second-trimester miscarriage, fetal hypocalcaemia and secondary hyperparathyroidism, bone demineralization and neonatal rickets. Vitamin D deficiency is common in non-Caucasian ethnic groups in the United Kingdom.
