Management of hyperthyroidism in pregnancy

Maternal hypertiroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods. There are several maternal and fetal complications during pregnancy, delivery and postpartum period. Correct management includes an accurate diagnosis, rigorous individualized treatment and minutious follow–up. We are presenting a retrospective study of 38 pregnant women who delivered in the Obstetric Unit of the University Emergency Bucharest Hospital in the past five years. We established a follow–up protocol in collaboration with endocrinologists. Precocious diagnosis of pregnancy is, in our opinion, mandatory. Accurate diagnosis of hormonal status beginning from the first week of pregnancy is of great importance. Maternal (weight, BP, TSH, thyroid hormones, ECG, etc.) and fetal (ultrasound, non–stress test, Doppler study) evaluation during pregnancy were rigorous performed. Results: abortion rate was 5%; 15% of pregnant women delivered prematurely; cesarean section rate was 22%; fetal outcome was excellent. Treatment adjustment during pregnancy was frequent, 28% of pregnant women had no hormonal treatment in the last trimester of pregnancy. Maternal complications were rare (poor weight gain, tachycardia). Fetal complications included low birth weight (24%), fetal respiratory distress (10%). Conclusions: team work with experienced endocrinologists and understanding of versatility of disease leads to good prognosis of mother and fetus in presence of hypertiroidism.