Hyperthyroidism during pregnancy find out what an overactive thyroid means for you and your baby. Emphasis on immunological aspects of thyroid disease and longacting thyroid stimulator lats. An endocrine society clinical practice guideline clinical guidelines the endocrine societys the endocrine society 8401 connecticut avenue, suite 900 chevy chase, md 20815 301. Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Gestational hyperthyroidism is a mild and selflimiting form of hyperthyroidism caused by tshr stimulation from elevated concentrations of human. Association of hyperthyroidism and pregnancy is not an unusual event, and has. Metabolic disorders, including thyroid dysfunction, are among the most common prepregnancy diseases in pregnant women.
Pdf file for saving and printing, 304 kb guest blog from the iodine global network timing matters for healthy iodine nutrition in the development of verbal iq in babies during pregnancy. Thyrotoxicosis results in a significant increase in the prevalence of low birth weight and a trend toward increased neonatal mortality. The high incidence of heart failure in these women con. Early recognition, accurate diagnosis, and appropriate management of thyrotoxicosis during pregnancy are important for decreasing the risks of adverse maternal and fetal outcomes. Full text full text is available as a scanned copy of the original print version. Thyrotoxicosis or hyperthyroidism is the clinical syndrome caused by an excess of circulating free thyroxine and free triiodothyronine, ft3 and ft4 or both.
Overall, the most common cause of hyperthyroidism in women of childbearing age is graves disease see graves disease brochure, which occurs in 0. During the past 10 years at the new york hospital, there have been 28 pregnancies complicated by hyperthyroidism. The effect of pregnancy on subsequent relapse from graves disease after. The committee on practice bulletinsobstetrics of the american college of obstetricians and gynecologists acog has developed a practice guideline on thyroid disease in pregnancy. Guidelines for tshreceptor antibody measurements in preg nancy. Aggravation of thyrotoxicosis in early pregnancy and after delivery in graves disease. Thyrotoxicosis in pregnancy and the postpartum period diagnosing thyrotoxicosis during pregnancy can be challenging as many physiological changes of pregnancy are similar to those of thyrotoxicosis. Patient 3 was 41 y old when she was found to be thyrotoxic during pregnancy. Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies.
The risk of fetal and neonatal thyrotoxicosis is not eliminated by previous thyroidectomy or 1 i therapy. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam. Gestational hyperthyroidism is a transient form of thyrotoxicosis caused by excessive stimulation of thyroid gland by hcg and usually limited to the first 1216 weeks of pregnancy. There are various causes of hyperthyroidism in pregnancy such as graves disease and gestational thyrotoxicosis. Aggravation of thyrotoxicosis in early pregnancy and after. Pregnancy and fetal development guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum the american thyroid association taskforce on thyroid disease during pregnancy and postpartum alex stagnarogreen chair,1 marcos abalovich,2 erik alexander,3 fereidoun azizi,4 jorge. Thyrotoxicosis and pregnancy europe pmc article europe. Outline treatment of hyperthyroidism during pregnancy.
Since the guidelines for the management of these disorders by the american thyroid association ata were first published in 2011, significant clinical and scientific advances have occurred in the field. Management of thyroid dysfunction during pregnancy and postpartum. In its classical form, transient thyrotoxicosis is followed by transient hypothyroidism with a return to the eu thyroid state by the end of the initial postpartum year 118. Thyrotoxicosis is a condition caused by an increase in the levels of thyroid hormone circulating in the blood. In early pregnancy, the thyroid is physiologically activated by asialohcg, and 3. Hyperthyroidism and pregnancy endocrinologia y nutricion. Guidelines of the american thyroid association for the. Physiologic changes in thyroid function during pregnancy thyroid binding globulin tbg increases due to reduced hepatic clearance and estrogenic stimulation of tbg synthesis. Pdf file for saving and printing, 948 kb iodine and the thyroid iodine supplementation lowers the longterm risk of thyrotoxicosis without increasing hypothyroidism iodine deficiency is a worldwide health problem affecting about 30% of the population. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to physiological adaptation of normal pregnancy. It is well known that the clinical course of autoimmune thyroid disease is markedly influenced by pregnancy. Yoshinori iwatani, takako yamada, keiichi kurachi, yuichi kumahara, kiyoshi miyai, aggravation of thyrotoxicosis in early pregnancy and after delivery in graves disease, the journal of clinical endocrinology. Thyrotoxicosis and pregnancy thyroid research full text. Thyrotoxicosis treatment what do you need to know and doctors dont have time to tell you.
Thyroid problems can be hard to diagnose in pregnancy due to higher levels of thyroid hormones and other symptoms that occur in. Management of thyroid dysfunction during pregnancy and. There is disagreement in regard to the management of these patients. Overtreatment may lead to hypothyroidism in the fetus, which is associated with subtle neurocognitive deficits later on in life. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to. A third cause of thyrotoxicosis in a newborn is the transfer of thyroidstimulating antibodies in the mothers milk. In addition to other usual causes of hyperthyroidism see hyperthyroidism brochure, very high levels of hcg, seen in severe forms of morning sickness hyperemesis gravidarum, may cause transient hyperthyroidism in early pregnancy.
Overt hyperthyroidism low thyroidstimulating hormone tsh, elevated free thyroxine t4 andor triiodothyronine t3 is relatively uncommon during pregnancy, occurring in 0. Thyroid disorders are commonly separated into two major categories, hyperthyroidism and hypothyroidism, depending on whether serum thyroid hormone. There are three treatment options for thyrotoxicosis due to graves disease. Hyperthyroidism in pregnancy american thyroid association. A family history of thyroid disease or autoimmune disease can also increase your risk certain medicines, such as heart medicines used to. An autoimmune disease is an immune system problem that may make your thyroid gland produce too much thyroid hormone. Hyperthyroidism in pregnancy what you need to know. Pharmacological sciences management of thyrotoxic crisis. Get a printable copy pdf file of the complete article 1. Links to pubmed are also available for selected references. Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, and induced thyroxine overdose. It can also occur in hydatidiform mole and choriocarcinoma. This document describes evidencebased clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others. Association of maternal iodine status with child iq.
Thyrotoxicosis in pregnancy fetal and maternal medicine. It affects % of all pregnancies, especially the women with hyperemesis gravidarum and multiple gestation. Diagnosis and treatment of hyperthyroidism in pregnancy. Diagnosis and management of thyrotoxicosis the bmj. In europe, it affects around 1 in 2000 people annually. Paul hospital, thessaloniki, greece abstract the most common thyroid diseases during pregnancy are hyper and hypothyroidism and their. For those with good control on antithyroid drugs or with previously treated graves disease in remission, the maternal and fetal outcome is usually good and unaffected by the thyrotoxicosis. It is caused by an activating antibody which targets the tsh receptor of the. The two terms however, tend to be used interchangeably. The diagnosis of pregnant women with hyperthyroidism parallels that of nonpregnant women and men but presents some unique problems.
Current guidelines by the american thyroid association, american association of clinical endocrinologists, and the endocrine society recommend that trimester. Racgp evaluating and managing patients with thyrotoxicosis. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. Graves disease is an example of an autoimmune disease that increases thyroid hormone. During the 12year period from 1974 through 1985, nearly 120,000 women were delivered of infants at parkland hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them 1. Get info on causes, risks, treatments and prevention of hyperthyroidism during pregnancy at. Thyrotoxicosis and heart failure that complicate pregnancy. Effect of thyrotoxicosis on pregnancy if thyrotoxicosis is severe and untreated. Gd in pregnant women, the different consensuses and clinical guidelines6,7. The prevalence of thyrotoxicosis subclinical or overt reported among those without a history of thyroid disease in australia is approximately 0.
Rodien et al15 reported some cases of gestational transient thyrotoxicosis which have similar human chorionic gonadotropin level to the normal pregnancy condition and they found that there is a mutation of thyroid stimulating hormone receptor. Bibliographies, discussions, and name and subject indexes. Acog practice bulletin on thyroid disease in pregnancy. The determination of tsh receptor antibodies tshrab or thyroid stimulating immunoglobulins tsi is indicated in mothers in whom previous pregnancies have been complicated by fetal or neonatal hyperthyroidism, in mothers with active disease on antithyroid drug therapy, in mothers with thyroidectomy during pregnancy. Thyroid disease in pregnancy is a common clinical problem. We have not encountered this situation in practice 16. Free t 4 and free t 3 were table 1 unusual causes of thyrotoxicosis. Burch and wartofskys scoring system table i is helpful in distinguishing thyroid storm, impending storm and uncomplicated thyrotoxicosis21. Thyrotoxicosis presenting in pregnancy can be particularly challenging, given the normal physiologic changes which occur and limitations of laboratory and radiologic testing during pregnancy.
Not a systematic presentation of all aspects of thyrotoxicosis. Thyrotoxicosis during pregnancy is suggested by a suppressed. Thyrotoxicosis in the case of an activated tsh receptor or g protein is permanent until all thyroid tissue has been removed 9,14,15. Hyperthyroidism is an excessive concentration of thyroid hormones.
Also discussion of use of antithyroid drugs and 1 i, function tests in pregnancy, thyrocalcitonin deficiency, and other topics. Management of hyperthyroidism during pregnancy and lactation. Thyrotoxicosis of pregnancy can present unique diagnostic challenges and, if untreated, is associated with increased risks of adverse maternal, fetal, and neonatal complications. Thyrotoxicosis in pregnancy europe pmc article europe pmc. Graves disease is the commonest cause of thyrotoxicosis being more common in females than males. Thyrotoxicosis is common in the australian population and thus a frequent clinical scenario facing the general practitioner. The risk of fetal thyrotoxicosis is about 1% of all pregnancies in women with graves disease, and if untreated, fetal mortality may be as high as 24%. The management of thyrotoxicosis in pregnancy nejm. The clinical manifestations of thyrotoxicosis in pregnancy can be confusingbecause pregnancy has similar manifestations, such as palpitations and heat intolerance. Comparative frequency of four different types of pregnancy. Repeating thyroid function tests within a few weeks of the. Introduction thyroid disorder is a general term representing several different diseases involving thyroid hormones and the thyroid gland. Nevertheless, the distinction between severe but compensated thyrotoxicosis com.
Ppt is the occurrence of thyroid dysfunction in the. A case report bola r kamath 1, kamla j rao, adikari ak mayadunne2 abstract. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Karras,2 nikolaos pontikides2 1cultural and educational center g. Current guidelines by the american thyroid association, american association of clinical endocrinologists, and the endocrine society. Fertility is not affected by 1 i therapy for thyrotoxicosis, but pregnancy should be deferred for 46 months after 1 i therapy, although the basis of this recommendation is largely empirical. Get a printable copy pdf file of the complete article 281k, or click on a page image below to browse page by page. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the etiology of thyrotoxicosis.