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Transient hyperthyroidism of hyperemesis gravidarum
Jackie Y L Tan1, Keh Chuan Loh, George S H Yeo
1Department of General Medicine, Tan Tock Seng Hospital, Singapore.
Summary
Transient hyperthyroidism in hyperemesis gravidarum typically resolves by mid-pregnancy without treatment. Routine thyroid screening is unnecessary unless clinical signs of hyperthyroidism are present.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Maternal-Fetal Medicine
Background:
- Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy.
- Transient hyperthyroidism can occur in some cases of hyperemesis gravidarum.
- Understanding the clinical and biochemical profile is crucial for management.
Purpose of the Study:
- To characterize the clinical, biochemical, and thyroid antibody profile in pregnant women with hyperemesis gravidarum-associated transient hyperthyroidism.
- To assess pregnancy outcomes in this cohort.
- To determine the necessity of routine thyroid function testing.
Main Methods:
- Prospective observational study in a hospital setting.
- Recruited women admitted with hyperemesis gravidarum and diagnosed with hyperthyroidism.
- Assessed clinical signs, performed biochemical tests (urea, creatinine, electrolytes, LFTs), thyroid antibodies, and serial thyroid function tests.
Main Results:
- Thyroid function normalized by 15 weeks gestation in most cases, with suppressed TSH until 19 weeks.
- Most women lacked clinical hyperthyroidism and thyroid antibodies.
- A trend towards lower birthweights was observed in mothers with significant weight loss (>5%).
- Five women were diagnosed with Graves' disease.
Conclusions:
- Transient hyperthyroidism in hyperemesis gravidarum resolves spontaneously by the second trimester.
- Overt hyperthyroidism and thyroid antibodies are uncommon.
- Pregnancy outcomes are generally favorable, with a non-significant trend for lower birthweights in severely affected mothers.
- Routine thyroid function tests are not indicated without clinical suspicion.
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