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Hyperthyroidism and Pregnancy.

Kristen Kobaly1, Susan J Mandel1

  • 1Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 4th Floor West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.

Endocrinology and Metabolism Clinics of North America
|July 27, 2019
PubMed
Summary
This summary is machine-generated.

Hyperthyroidism in pregnancy, often Graves' disease, requires careful management of antithyroid drugs due to teratogenicity risks. Monitoring thyrotropin receptor antibodies helps identify pregnancies at risk for fetal and neonatal hyperthyroidism.

Keywords:
Gestational thyrotoxicosisGraves' diseaseHyperthyroidismLactationTRAbTeratogenicityThionamides

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Area of Science:

  • Endocrinology
  • Obstetrics
  • Reproductive Medicine

Background:

  • Hyperthyroidism complicates 0.1%–0.4% of pregnancies.
  • Gestational thyrotoxicosis arises from human chorionic gonadotropin (HCG) stimulating the TSH receptor.
  • Graves' disease (GD) is the most frequent cause of clinically significant hyperthyroidism during pregnancy.

Purpose of the Study:

  • To outline the management of hyperthyroidism in pregnancy, focusing on Graves' disease.
  • To discuss the risks and therapeutic strategies for antithyroid drug use.
  • To highlight methods for identifying pregnancies at risk for fetal and neonatal hyperthyroidism.

Main Methods:

  • Review of current clinical practices for managing hyperthyroidism in pregnancy.
  • Discussion of antithyroid drug selection (propylthiouracil, methimazole) based on trimester and risk.
  • Emphasis on the role of thyrotropin receptor antibodies in risk assessment.

Main Results:

  • Antithyroid drugs may be discontinued in low-risk GD patients due to teratogenicity concerns.
  • High-risk patients are treated with propylthiouracil initially, potentially transitioning to methimazole.
  • Graves' disease may remit late in pregnancy, with common postpartum relapse.

Conclusions:

  • Management strategies for hyperthyroidism in pregnancy prioritize fetal safety and maternal health.
  • Thyrotropin receptor antibody measurement is crucial for predicting fetal and neonatal outcomes.
  • Postpartum monitoring is essential due to the high likelihood of relapse.