Graves disease, the most common cause of thyrotoxicosis in pregnancy, is an autoimmune condition characterized by production of thyroidstimulating immunoglobulin tsi and thyroidstimulating hormone binding inhibitory immunoglobulin tbii these two antibodies facilitate the thyroidstimulating hormone tsh receptor in the mediation of thyroid stimulation and inhibition. According to recent guidelines, the measurement of the tsh receptor. Hyperthyroidism in pregnancy american thyroid association. This can cause destruction of the gland and result in permanent hypothyroidism. Nearly 80% of responders do not treat subclinical hyperthyroidism in pregnancy. Hyperthyroid during pregnancy is not so unusual, but hyperthyroidism can spell trouble for pregnant women. Treatment adjustment during pregnancy was frequent, 28% of pregnant women had.
Thyroid dysfunction affects 23% of pregnant women and one in 10 women of childbearing age with normal thyroid function have underlying thyroid autoimmunity, which may indicate reduced functional reserve. Hyperthyroidism in pregnancy is usually caused by graves disease and occurs in 1 to 4 of every 1,000 pregnancies in the united states. Both hypothyroidism and hyperthyroidism can affect fertility. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy. Serum tsh should be measured in pregnant women who are being treated for hypothyroidism at four to six weeks gestation, then every four to six weeks until 20 weeks gestation and on a stable medication dosage, then again at 24 to 28 weeks and 32 to 34 weeks gestation. About 1 in 500 women have hyperthyroidism during pregnancy. Hyperthyroidism during pregnancy is uncommon and has been. Four of the infants had a goiter at birth, and 3 of these had neonatal thyrotosicosis. Management of hyperthyroidism in pregnancy springerlink. A number of important issues gerasimos krassas,1 spyridon n. Hyperthyroidism caused by overproduction of thyroid hormones can be treated with antithyroid medications methimazole and propylthiouracil, radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. Radioactive iodine ablation is the most widely used treatment in the united states. Identification of hyperthyroidism in a pregnant woman is important because.
Graves disease is an example of an autoimmune disease that increases thyroid hormone. Graves disease is a complex autoimmune disorder, characterized by autoantibodies that activate the tsh receptor. Hyperthyroidism is a pathological disorder in which excess thyroid hormone is synthesised and secreted by the thyroid gland. 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 hyperthyroidism during pregnancy in asia. Radioactive iodine should be completed at least 6 months prior to pregnancy. 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.
Management of hyperthyroidism during pregnancy and lactation. Outline treatment of hyperthyroidism during pregnancy. An autoimmune disease is an immune system problem that may make your thyroid gland produce too much thyroid hormone. Spectrum of hyperthyroidism in pregnancy graves disease constitutes 95% of hyperthyroidism cases in pregnancy. Radioiodine is contraindicated to treat hyperthyroidism during pregnancy since it readily crosses the placenta and is taken up by the babys thyroid gland. Antithyroid drugs can be safely used during pregnancy to control maternal hyperthyroidism when their limitations are noted. Treatment of hyperthyroidism in pregnancy and birth. Hypothyroidism can occur during pregnancy due to the initial presentation of hashimotos thyroiditis, inadequate treatment of a woman already known to have hypothyroidism from a variety of causes, or overtreatment of a hyperthyroid woman with antithyroid medications. Pdf poorly treated or untreated maternal overt hyperthyroidism may. Symptoms of hyperthyroidism common in pregnancy heat intolerance. Thyroid conditions raise the risk of pregnancy complications. In women who have underlying hyperthyroidism, in particular graves disease, uncontrolled disease may have detrimental effects on the pregnancy for both more and child. It refers to problems resulting from a glut of thyroid hormone, which is produced by this gland. Thyroid disease in pregnancy american family physician.
Doctors typically recommend that all women with raves disease become euthyroid before pregnancy. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid. Mmi is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. As treating hyperthyroidism during pregnancy is a balance between adverse outcomes related to treatment. Overall, the most common cause of hyperthyroidism in women of childbearing age is graves disease see graves disease brochure, which occurs in 0. Hyperthyroidism in pregnancy the incidence of hyperthyroidism in pregnant women has been estimated at 0. A family history of thyroid disease or autoimmune disease can also increase your risk certain medicines, such as heart medicines used to. In women with hypothyroidism, levo thyroxine is titrated to achieve a goal serum thyroidstimulating hormone level less than 2. Thyroid disease in pregnancy is a common clinical problem. Twentyone women were studied nhu had received propylthiouracil or methimuzole during 26 pregnancies. Hypothyroidism in pregnancy american thyroid association. Clinical hyperthyroidism is not uncommon in pregnancy, with a reported prevalence of 0. Get info on causes, risks, treatments and prevention of hyperthyroidism during pregnancy at.
Thus, hyperthyroidism in pregnant women should be carefully managed. The goal of antithyroid drug treatment is to normalize maternal free. Diagnosis and management of hyperthyroidism in pregnancy. This state is risky for a woman at risk of hyperthyroidism and can exacerbate symptoms of the condition if they had it before the pregnancy. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. Common in pregnancy heat intolerance diaphoresis fatigue anxiety emotional lability tachycardia wide pulse pressure nauseavomiting abnormal in pregnancy weight loss pulse 100 bpm diffuse goiter tremor systolic htn diarrhea. Diagnosis and treatment of hyperthyroidism in pregnancy.
Surgical removal of the thyroid gland is safest in the second trimester. Graves disease, which is autoimmune in nature, is the usual cause. On the other hand, transient central hypothyroidism may be seen in infants whose mothers had poorly controlled hyperthyroidism during pregnancy, presumably due to suppression of the fetal pituitarythyroid axis. The use of antithyroid drugs in pregnancy and lactation. Pdf management of hyperthyroidism during pregnancy and lactation. Management of thyroid dysfunction during pregnancy and. Discuss options for women with known hyperthyroidism well before planned conception if possible. Hyperthyroidism in pregnancy what you need to know. Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, and induced thyroxine overdose. Methimazole should be started in the second trimester and continued for the remainder of pregnancy. Karras,2 nikolaos pontikides2 1cultural and educational center g. It can be difficult to diagnose because the pregnancy often masks it. 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. Suppression therapy is used primarily in patients with thyroid cancer to prevent recurrence or progression of their cancer.
The preferred treatment for hyperthyroidism is antithyroid medications, with a goal of maintaining a serum free thyroxine level in the upper onethird of the normal range. Methimazole will be used for the second and third trimesters. Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, exces sive release of preformed thyroid hormones, or an endogenous or. Approximately one to two cases of gestational hyperthyroidism occur per pregnancies. Thyroid hormone treatment american thyroid association. The most common cause of hyperthyroidism during pregnancy is graves disease. However, treatment with antithyroid medications for overactive thyroid hyperthyroidism was linked with a higher risk of preterm births, low birth weights and infant death. Guidelines for tshreceptor antibody measurements in preg. Hyperthyroidism during pregnancy find out what an overactive thyroid means for you and your baby. An endocrine society clinical practice guideline clinical guidelines the endocrine societys the endocrine society 8401 connecticut avenue, suite 900 chevy chase, md 20815 301. Management of thyroid dysfunction during pregnancy and postpartum. The treatment of choice in pregnancy is antithyroid drugs atds. In all pregnancies, hyperthyroidism occurs in almost 0. Maternal hyperthyroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods.
This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The goal of treatment is to maintain clinical euthyroidism, with the mothers ft4 level in the highnormal range. Autoimmune thyroid disease and pregnancy treatment. It is characterised by normal or high thyroid radioactive iodine uptake thyrotoxicosis with hyperthyroidism or true hyperthyroidism. Assessment of thyroid function during pregnancy should be done with a careful clinical evaluation of the patients symptoms as well as measurement of tsh and free, not total, thyroid hormones7 figs. No controlled trials of management have been conducted, but consensus guidelines have recently been. Clinical manifestations, diagnosis, and causes and overview of thyroid. 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.
Thyrotoxicosis of pregnancy can present unique diagnostic challenges and, if untreated, is associated with increased risks of adverse maternal, fetal, and neonatal complications. Overt hyperthyroidism in pregnancy requires treatment with suppressive thyrostatic agents to ensure maternal euthyroid status. Overtreatment of maternal hyperthyroidism with thionamide antithyroid drugs atds can cause fetal goiter and primary hypothyroidism. Hyperthyroidism in pregnancy brochure pdf american thyroid. Current international guidelines recommend the use of ptu in the first trimester of. Physiological changes of thyroid during pregnancy 1. Thyroid conditions raise the risk of pregnancy complications written by julia haskins on may 29, 20 thyroid conditions present risks for pregnant women and their babies. A large study from denmark found that exposure to levothyroxine, used to help a sluggish thyroid hypothyroidism, had no impact on birth weight and other factors. In order to prevent overtreatment and possible neonatal hypothyroidism, the lowest dose possible should be used to keep maternal free.
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 hyperthyroidism. Appropriate diagnosis and treatment of hyperthyroidism during pregnancy are. Establishing the correct diagnosis and effectively managing graves hyperthyroidism in pregnancy remains a challenge for physicians. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the. Hypothyroidism and hyperthyroidism during pregnancy. Achieving a euthyroid state may in itself restore normal fertility. If performed after pregnancy, radioactive iodine will contraindicate lactation requires avoiding close contact with the infant for a period of time. Thyroid disorders in pregnancy article pdf available in the journal of the association of physicians of india 59 supplsuppl. The treatment of pregnant women with hyperthyroidism parallels that of. August 16, 2018 in 2018 news releases, basic science research, news releases, thyroid disease and pregnancy, thyroid research grants research grant to study the action of tregulatory cells in thyroidantibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association. The antithyroid drug is propyethionavil especially during the 1st trimester, because methimazole has a slightly higher risk of birth defects.
The clinical manifestations, diagnosis, and causes of hyperthyroidism and other aspects of thyroid disease during pregnancy are discussed separately. With this disease, your immune system makes antibodies that cause the thyroid to make too much thyroid hormone. Exceptional, hyperthyroidism in pregnancy has a different cause other than graves. Therefore, despite wide variations in the management of hyperthyroidism during pregnancy in asia, majority of asian physicians practice within the recommendations of major professional societies. Paul hospital, thessaloniki, greece abstract the most common thyroid diseases during pregnancy are hyper and hypothyroidism and their.