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Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development
The management of hyperthyroidism in pregnant patients has been a topic of raised clinical awareness for decades. It is a strong recommendation that overt hyperthyroidism of Graves’ disease in pregnant women should be treated to prevent complications. The consequences of hyperthyroidism in pregnancy...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Bioscientifica Ltd
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983517/ https://www.ncbi.nlm.nih.gov/pubmed/33444223 http://dx.doi.org/10.1530/EC-20-0518 |
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author | Andersen, Stine Linding Andersen, Stig |
author_facet | Andersen, Stine Linding Andersen, Stig |
author_sort | Andersen, Stine Linding |
collection | PubMed |
description | The management of hyperthyroidism in pregnant patients has been a topic of raised clinical awareness for decades. It is a strong recommendation that overt hyperthyroidism of Graves’ disease in pregnant women should be treated to prevent complications. The consequences of hyperthyroidism in pregnancy are less studied than hypothyroidism, and a literature review illustrates that the main burden of evidence to support current clinical guidance emerges from early observations of severe complications in Graves’ disease patients suffering from untreated hyperthyroidism in the pregnancy. On the other hand, the more long-term consequences in children born to mothers with hyperthyroidism are less clear. A hypothesis of fetal programming by maternal hyperthyroidism implies that excessive levels of maternal thyroid hormones impair fetal growth and development. Evidence from experimental studies provides clues on such mechanisms and report adverse developmental abnormalities in the fetal brain and other organs. Only few human studies addressed developmental outcomes in children born to mothers with hyperthyroidism and did not consistently support an association. In contrast, large observational human studies performed within the last decade substantiate a risk of teratogenic side effects to the use of antithyroid drugs in early pregnancy. Thus, scientific and clinical practice are challenged by the distinct role of the various exposures associated with Graves’ disease including the hyperthyroidism per se, the treatment, and thyroid autoimmunity. More basic and clinical studies are needed to extend knowledge on the effects of each exposure, on the potential interaction between exposures and with other determinants, and on the underlying mechanisms. |
format | Online Article Text |
id | pubmed-7983517 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-79835172021-03-24 Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development Andersen, Stine Linding Andersen, Stig Endocr Connect Review The management of hyperthyroidism in pregnant patients has been a topic of raised clinical awareness for decades. It is a strong recommendation that overt hyperthyroidism of Graves’ disease in pregnant women should be treated to prevent complications. The consequences of hyperthyroidism in pregnancy are less studied than hypothyroidism, and a literature review illustrates that the main burden of evidence to support current clinical guidance emerges from early observations of severe complications in Graves’ disease patients suffering from untreated hyperthyroidism in the pregnancy. On the other hand, the more long-term consequences in children born to mothers with hyperthyroidism are less clear. A hypothesis of fetal programming by maternal hyperthyroidism implies that excessive levels of maternal thyroid hormones impair fetal growth and development. Evidence from experimental studies provides clues on such mechanisms and report adverse developmental abnormalities in the fetal brain and other organs. Only few human studies addressed developmental outcomes in children born to mothers with hyperthyroidism and did not consistently support an association. In contrast, large observational human studies performed within the last decade substantiate a risk of teratogenic side effects to the use of antithyroid drugs in early pregnancy. Thus, scientific and clinical practice are challenged by the distinct role of the various exposures associated with Graves’ disease including the hyperthyroidism per se, the treatment, and thyroid autoimmunity. More basic and clinical studies are needed to extend knowledge on the effects of each exposure, on the potential interaction between exposures and with other determinants, and on the underlying mechanisms. Bioscientifica Ltd 2021-01-06 /pmc/articles/PMC7983517/ /pubmed/33444223 http://dx.doi.org/10.1530/EC-20-0518 Text en © 2021 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Review Andersen, Stine Linding Andersen, Stig Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title | Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title_full | Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title_fullStr | Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title_full_unstemmed | Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title_short | Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
title_sort | hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983517/ https://www.ncbi.nlm.nih.gov/pubmed/33444223 http://dx.doi.org/10.1530/EC-20-0518 |
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