Korean J Obstet Gynecol.  2010 Sep;53(9):795-803. 10.5468/kjog.2010.53.9.795.

Perinatal outcome of pregnancy with hyperthyroidism

• Ko HS
• Jang DG
• Shin JE
• Kim YH
• Park IY
• Shin JC

• KMID: 2077997
• DOI: http://doi.org/10.5468/kjog.2010.53.9.795

Abstract

OBJECTIVE
To evaluate the maternal and neonatal outcomes of pregnancies complicated with hyperthyroidism, according to the maternal treatment and thyroid function status during pregnancy.
METHODS
This retrospective study was conducted on women complicated by hyperthyroidism who delivered between January 2000 and March 2010, at Catholic University Medical Center. The baseline characteristics as well as maternal and fetal outcomes were analyzed and compared according to maternal antithyroid medication and thyroid function status.
RESULTS
Among 163 pregnant women complicated with hyperthyroidism, 103 women received antithyroid medication and 109 women showed euthyroid status during pregnancy. The mean gestational age and fetal birth weight at delivery were 38.2+/-2.9 weeks and 2.99+/-0.64 kg. There was no statistical difference in maternal complications between the medication group (n=103) and the non-medication group (n=59), while neonatal thyroid dysfunction including transient hypothyroidism was significantly higher in the medication group than the non-medication group (58% vs 24.5%, P<0.0001). The incidence of admission due to hyperemesis and neonatal thyroid dysfunction were significantly higher in the thyroid dysfunction group than the euthyroid group (21.7% vs 4.6%, P=0.0146; 66.7% vs 39.4%, P=0.0223, respectively).
CONCLUSION
Maternal antithyroid medication as well as thyroid dysfunction during pregnancy could indicate the careful fetal thyroid monitoring to prevent neonatal thyroid dysfunction.

Keyword

Pregnancy; Hyperthyroidism

MeSH Terms

Academic Medical Centers
Birth Weight
Female
Gestational Age
Humans
Hyperthyroidism
Hypothyroidism
Incidence
Pregnancy
Pregnant Women
Retrospective Studies
Thyroid Gland

Reference

1. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 37, August 2002. (Replaces Practice Bulletin Number 32, November 2001). Thyroid disease in pregnancy. Obstet Gynecol. 2002. 100:387–396.

2. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol. 1989. 160:63–70.

3. Lim BH, Raman S, Sivanesaratnam V, Ngan A. Thyrotoxicosis in pregnancy-a six year review. Singapore Med J. 1989. 30:539–541.

4. Kimura M, Amino N, Tamaki H, Mitsuda N, Miyai K, Tanizawa O. Physiologic thyroid activation in normal early pregnancy is induced by circulating hCG. Obstet Gynecol. 1990. 75:775–778.

5. Kriplani A, Buckshee K, Bhargava VL, Takkar D, Ammini AC. Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol. 1994. 54:159–163.

6. Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol. 1994. 84:946–949.

7. Gharib H, Cobin RH, Dickey RA. Subclinical hypothyroidism during pregnancy: position statement from the American Association of Clinical Endocrinologists. Endocr Pract. 1999. 5:367–368.

8. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007. 92:203–207.

9. Wing DA, Millar LK, Koonings PP, Montoro MN, Mestman JH. A comparison of propylthiouracil versus methimazole in the treatment of hyperthyroidism in pregnancy. Am J Obstet Gynecol. 1994. 170:90–95.

10. Mandel SJ. Copper DS, editor. Thyroid disease and pregnancy. Medical management of thyroid disease. 2001. New York: Marcel Dekker;387–418.

11. Clementi M, Di Gianantonio E, Pelo E, Mammi I, Basile RT, Tenconi R. Methimazole embryopathy: delineation of the phenotype. Am J Med Genet. 1999. 83:43–46.

12. Mandel SJ, Brent GA, Larsen PR. Review of antithyroid drug use during pregnancy and report of a case of aplasia cutis. Thyroid. 1994. 4:129–133.

13. Momotani N, Noh JY, Ishikawa N, Ito K. Effects of propylthiouracil and methimazole on fetal thyroid status in mothers with Graves' hyperthyroidism. J Clin Endocrinol Metab. 1997. 82:3633–3636.

14. O'Doherty MJ, McElhatton PR, Thomas SH. Treating thyrotoxicosis in pregnant or potentially pregnant women. BMJ. 1999. 318:5–6.

15. Brand F, Liegeois P, Langer B. One case of fetal and neonatal variable thyroid dysfunction in the context of Graves' disease. Fetal Diagn Ther. 2005. 20:12–15.

16. Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, et al. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab. 2005. 90:6093–6098.

17. Rosenfeld H, Ornoy A, Shechtman S, Diav-Citrin O. Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. Br J Clin Pharmacol. 2009. 68:609–617.

18. Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R. Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn. 2003. 23:740–742.

19. Thorpe-Beeston JG, Nicolaides KH, Felton CV, Butler J, McGregor AM. Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus. N Engl J Med. 1991. 324:532–536.

20. Van Vliet G. Treatment of congenital hypothyroidism. Lancet. 2001. 358:86–87.

21. Nachum Z, Rakover Y, Weiner E, Shalev E. Graves' disease in pregnancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol. 2003. 189:159–165.

22. Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Arch Gynecol Obstet. In Press 2010.

23. Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med. 1994. 331:1072–1078.