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Thyrotoxicosis and heart failure that complicate pregnancy
Jeanne S Sheffield1, F Gary Cunningham
1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, 75390-9032, USA. Jeanne.Sheffield@UTSouthwestern.edu
American Journal of Obstetrics and Gynecology
|January 30, 2004
Summary
Graves' thyrotoxicosis can cause heart failure in pregnant women, often linked to obstetric complications. Successful treatment of thyrotoxicosis and pregnancy factors leads to reversible cardiac dysfunction.
Area of Science:
- Cardiology
- Endocrinology
- Obstetrics
Background:
- Graves' thyrotoxicosis presents significant cardiovascular risks, rarely leading to heart failure in healthy individuals.
- Pregnant women with Graves' thyrotoxicosis may be an exception, with preliminary data suggesting an increased risk of heart failure.
Purpose of the Study:
- To investigate the immediate and long-term cardiovascular outcomes in pregnant women experiencing heart failure due to thyrotoxicosis.
- To elucidate the association between Graves' thyrotoxicosis and heart failure during pregnancy.
Main Methods:
- Retrospective review of clinical outcomes for pregnant women with Graves' disease and heart failure (1974-2001).
- Exclusion of patients with pre-existing heart conditions.
- Standardized antithyroid treatment, serial echocardiography, and chest radiography were employed.
Main Results:
- Thirteen women with thyrotoxicosis and heart failure were identified; most had poor adherence to treatment or lacked medical care.
- Heart failure was often precipitated by obstetric complications such as hemorrhage, sepsis, or severe preeclampsia-eclampsia.
- Long-term follow-up (2-25 years) in 11 women confirmed resolution of cardiomyopathy after successful thyrotoxicosis treatment.
Conclusions:
- Pregnancy can amplify the hyperdynamic cardiovascular state seen in thyrotoxicosis.
- Common pregnancy complications can precipitate heart failure in susceptible women.
- Prompt treatment of heart failure and underlying causes results in favorable outcomes, with reversible cardiac dysfunction.