Pregnancy may affect the course of these thyroid disorders, and conversely, thyroid diseases may affect the course of pregnancy. The most common cause of hyperthyroidism during pregnancy is graves disease. Graves disease is an autoimmune disorder characterized by an overproduction of the thyroid gland, which leads to hyperthyroidism there is no treatment or therapy required for those pregnant women who only have a slight increase of their thyroid hormones. Graves disease, which is autoimmune in nature, is the usual cause. Maternal hyperthyroidism and pregnancy complications. Luckily in the majority of the cases when thinking about hyperthyroidism and pregnancy there is treatment that is really efficient.
Hyperthyroidism in pregnancy what you need to know. Graves disease is an example of an autoimmune disease that increases thyroid hormone. The disease usually gets worse in the first trimester but typically moderates later in pregnancy. Sometimes a general physician can diagnose and treat the cause of hyperthyroidism, but assistance is often needed from an endocrinologist, a physician who specializes in managing thyroid disease.
Treatment adjustment during pregnancy was frequent, 28% of pregnant. Diagnosis and management of hyperthyroidism in pregnancy. Overall, the benefits to the baby of treating a mother with hyperthyroidism during pregnancy outweigh the risks if therapy is carefully monitored. Management of hyperthyroidism during pregnancy and lactation. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is. Treatment of hyperthyroidism in pregnancy and birth. Hyperthyroidism is thyrotoxicosis arising from the thyroid. Clinical hyperthyroidism is not uncommon in pregnancy, with a reported prevalence of 0. Management of hyperthyroidism in pregnancy springerlink. Pregnant women with hyperthyroidism need careful management as some may be at increased risk of fetal loss, preeclampsia, heart failure, premature labour, and having a low birthweight baby various problems may arise in the management of a pregnant patient with hyperthyroidism see scenario box. Both of these drugs cross the placenta and can potentially impair the babys thyroid function and cause fetal goiter. Hyperthyroidism in pregnancy is usually caused by graves disease and occurs in 1 to 4 of every 1,000 pregnancies in the united states.
In fact, less than 2 percent of babies born to mamas with graves disease suffer from hyperthyroidism themselves. Although nausea is common in early pregnancy, the occurrence of hyperemesis gravidarum. Serum thyroxinebinding globulin tbg increases by twofold due to estrogen. The outcome of the pregnancy may also be threatened, having a premature birth or the baby having a low birth weight. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid. Establishing the correct diagnosis and effectively managing graves hyperthyroidism in pregnancy remains a challenge for physicians. Moreover, thyroid disorders and their management may affect both the pregnant woman and the. Management of thyroid dysfunction during pregnancy and. Clinical manifestations, diagnosis, and causes and overview of thyroid disease and pregnancy. Identification of hyperthyroidism in a pregnant woman is important because. The prevalence of hyperthyroidism overactive thyroid during pregnancy ranges from 0. The diagnosis is based on high levels of thyroid hormones, t3 and t4, and a low level of thyroid stimulating hormone tsh. Thyroid diseases are among the most common endocrine disorders encountered during pregnancy. Having too much thyroid hormone speeds up the way the body uses energy and controls growth.
Thyroid problems are more common among women and are especially prevalent during pregnancy. Graves disease is a complex autoimmune disorder, characterized by autoantibodies that activate the tsh receptor. Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. Subclinical hypothyroidism is defined by a normal free thyroxine in the presence of an elevated thyroidstimulating hormone tsh. Spectrum of hyperthyroidism in pregnancy graves disease constitutes 95% of hyperthyroidism cases in pregnancy. Iodineinduced hyperthyroidism can occur after intake of excess iodine in the diet, exposure to radiographic contrast media, or medications. An estimated 300,000 pregnancies annually in the u. Managing thyroid disease during pregnancy, new ata guidelines. Graves disease is the most common cause of hyperthyroidism during pregnancy.
Hypothyroidism and hyperthyroidism sharon witemeyer md pediatrician introduction. Graves hyperthyroidism in pregnancy clinical diabetes and. Diagnosis and treatment of hyperthyroidism in pregnancy. Maternal hyperthyroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods. The diagnosis of hyperthyroidism in pregnancy can be complicated since some of the blood tests used for the diagnosis are altered because of the pregnancy. About 1 in 500 women have hyperthyroidism during pregnancy. Risk of birth defects in the babies of women with thyroid.
The commonest cause of hyperthyroidism in pregnancy is graves disease due to stimulation of the thyroid by thyrotrophin receptorstimulating antibodies trab, but other causes such as toxic multinodular goiter, toxic adenoma, and subacute thyroiditis may occur. A family history of thyroid disease or autoimmune disease can also increase your risk certain medicines, such as heart medicines used to help you heart beat. Guidelines of the american thyroid association for the. Overt hyperthyroidism in pregnancy requires treatment with suppressive thyrostatic agents to ensure maternal euthyroid status. Paul hospital, thessaloniki, greece abstract the most common thyroid diseases during pregnancy are hyper and hypothyroidism and their. Overtreatment of maternal hyperthyroidism with thionamide antithyroid drugs atds can cause fetal goiter and primary hypothyroidism. Hyperthyroidism in pregnancy american thyroid association. Karras,2 nikolaos pontikides2 1cultural and educational center g. The most common cause of hyperthyroidism during pregnancy is graves disease 1.
Thyroid disease and pregnancy ppt linkedin slideshare. With this disease, your immune system makes antibodies that cause the thyroid to make too much thyroid hormone. An autoimmune disease is an immune system problem that may make your thyroid gland produce too much thyroid hormone. The task force consisted of international experts in the. Pdf thyrotoxicosis presenting during pregnancy is a common. Methimazole should be started in the second trimester and continued for the remainder of pregnancy. The himalayan goiter belt words largest belt from kashmir to naga hills. The reported prevalence of clinical hyperthyroidism in pregnancy is 0. Care requires coordination among several healthcare professionals.
Therefore, the american thyroid association does not believe that women with wellcontrolled thyroid disease run a significantly higher than normal risk of having a child with a birth defect. Thyrotoxicosis during pregnancy is suggested by a suppressed serum thyroid stimulating hormone tsh. Thyrotoxicosis of pregnancy article pdf available in journal of clinical and translational endocrinology 14 december 2014 with 1,426 reads how we measure reads. The goal of treatment is to maintain persistent but mild hyperthyroidism in the mother in an attempt to prevent fetal hypothyroidism since the fetal thyroid is more sensitive to the action of antithyroid drugs. Excess estrogen from pregnancy or estrogen therapy leads to elevated levels of thyroxinebinding globulin, which manifests as elevated total t. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Direct measurement of free thyroid hormone concentrations includes an. For several decades, pregnant women with this disorder have been treated with suppressive thyrostatic agents to. Mmi is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. It is in this context that the american thyroid association ata charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. Propylthiouracil ptu is the treatment of choice in any woman with graves disease planning pregnancy or in the first trimester as carbimazole is associated with a rare embryopathy. The incidence of hypothyroidism during pregnancy is estimated to be 0. Overview of treatment the endocrine society and the american thyroid association ata have published clinical guidelines for the management of thyroid dysfunction during pregnancy that are similar to the. Pregnancy is a period that places great physiological stress on both the mother and the fetus.
Dont worry just because you have hyperthyroidism doesnt mean youll pass it on to baby. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020, wolters kluwer updated. There is an antithyroid drug that is usually prescribed and it is safe even during. Radioactive iodine should be completed at least 6 months prior to pregnancy. Autoimmune thyroid disease and pregnancy treatment. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. If performed after pregnancy, radioactive iodine will contraindicate lactation requires avoiding close contact with the infant for a period of time. It can be difficult to diagnose because the pregnancy often masks it. Thyroid disease is an issue that can affect the health of mothers and their children both during and after pregnancy if contracted. The available antithyroid drugs atd are propylthiouracil ptu and methimazole mmicarbimazole cz. Ahmed om, abd eltawab sm, ahmed rg 2010 effects of experimentally induced maternal hypothyroidism and hyperthyroidism on the development of rat offspring. The most common causes of hyperthyroidism during pregnancy are graves diseaseand hcgmediated hyperthyroidism such as gestational transient hyperthyroidism, hyperemesis gravidarum. Postpartum thyroiditis can occur in up to 5 to 10 percent of women in the first three to six months after delivery. A number of important issues gerasimos krassas,1 spyridon n.
Discuss options for women with known hyperthyroidism well before planned conception if possible. Signs of hyperthyroidism in baby include an increased fetal. In order to prevent overtreatment and possible neonatal hypothyroidism, the lowest dose possible should be used to keep maternal free. The goal of treatment is to maintain clinical euthyroidism, with the mothers ft4 level in the highnormal range. Still, baby will need to be tested right after birth, just in case. Avoiding maternal and fetal hypothyroidism is of major importance because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Thyroid diseases affect up to 5% of all pregnancies.
The use of antithyroid drugs in pregnancy and lactation. The association always recommends that women with thyroid disease work closely with their doctor before and during their pregnancy, to ensure the best. Methimazole tapazole or propylthiouracil ptu are the atds available in the united states for the treatment of hyperthyroidism see hyperthyroidism brochure. The incidence of hyperthyroidism in the usa is 59 per pregnant women per year.
Discuss definitive management options prior to pregnancy. Hyperthyroidism in pregnancy brochure pdf american thyroid. Thousands of expecting mothers will be diagnosed with a disorder of the thyroid and will quickly learn that its a condition with the possibility of causing severe complications during pregnancy, as well as. Approximately one to two cases of gestational hyperthyroidism occur per pregnancies. Untreated hyperthyroidism poses considerable maternal and fetal risks, including preterm delivery, severe preeclampsia, heart failure, and thyroid storm 8. Fewer than 1 in 100 women has an overactive thyroid in pregnancy. The treatment of choice in pregnancy is antithyroid drugs atds.