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Hyperthyroidism during pregnancy: etiology, diagnosis and management
1Cardiff University, Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK. Lazarus@cf.ac.uk.
Women'S Health (London, England)
|October 7, 2009
Summary
Pregnancy alters thyroid function, often improving autoimmune thyroid disease due to immunosuppression. Monitoring thyroid hormones and antibodies is crucial for managing maternal and neonatal health, especially in cases of hyperthyroidism.
Area of Science:
- Endocrinology
- Immunology
- Obstetrics
Background:
- Pregnancy significantly impacts thyroid physiology.
- Autoimmune thyroid disease often improves during pregnancy due to immunosuppression.
- Trimester-specific thyroid hormone reference ranges are needed.
Purpose of the Study:
- To outline the effects of pregnancy on thyroid function.
- To provide guidance on managing hyperthyroidism during pregnancy.
- To highlight the importance of monitoring thyroid health in pregnant and postpartum women.
Main Methods:
- Review of current literature on thyroid physiology in pregnancy.
- Discussion of diagnostic and therapeutic strategies for thyroid disorders in pregnancy.
- Emphasis on specific monitoring protocols, including thyroid-stimulating hormone receptor antibody measurement.
Main Results:
- Hyperthyroidism in pregnancy, typically Graves' disease, can be managed with anti-thyroid drugs (propylthiouracil preferred) for good maternal and fetal outcomes.
- Thyroid-stimulating hormone receptor antibody measurement at 36 weeks can predict neonatal hyperthyroidism.
- Transient gestational hyperthyroidism associated with hyperemesis gravidarum requires thyroid function assessment.
Conclusions:
- Radioiodine therapy is contraindicated in pregnancy; thyroid surgery is safe in the second trimester.
- Postpartum women commonly experience autoimmune thyroiditis and Graves' hyperthyroidism.
- Careful management and monitoring of thyroid function are essential throughout pregnancy and the postpartum period.
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