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Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug

Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregna...

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Autores principales: Gheorghiu, Monica Livia, Bors, Roxana Georgiana, Gheorghisan-Galateanu, Ancuta-Augustina, Pop, Anca Lucia, Cretoiu, Dragos, Varlas, Valentin Nicolae
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396831/
https://www.ncbi.nlm.nih.gov/pubmed/34442037
http://dx.doi.org/10.3390/jcm10163742
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author Gheorghiu, Monica Livia
Bors, Roxana Georgiana
Gheorghisan-Galateanu, Ancuta-Augustina
Pop, Anca Lucia
Cretoiu, Dragos
Varlas, Valentin Nicolae
author_facet Gheorghiu, Monica Livia
Bors, Roxana Georgiana
Gheorghisan-Galateanu, Ancuta-Augustina
Pop, Anca Lucia
Cretoiu, Dragos
Varlas, Valentin Nicolae
author_sort Gheorghiu, Monica Livia
collection PubMed
description Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (<6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%); 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in T3; (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively; FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3; (d) no fetal birth defects were recorded; one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy.
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spelling pubmed-83968312021-08-28 Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug Gheorghiu, Monica Livia Bors, Roxana Georgiana Gheorghisan-Galateanu, Ancuta-Augustina Pop, Anca Lucia Cretoiu, Dragos Varlas, Valentin Nicolae J Clin Med Article Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (<6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%); 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in T3; (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively; FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3; (d) no fetal birth defects were recorded; one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy. MDPI 2021-08-23 /pmc/articles/PMC8396831/ /pubmed/34442037 http://dx.doi.org/10.3390/jcm10163742 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gheorghiu, Monica Livia
Bors, Roxana Georgiana
Gheorghisan-Galateanu, Ancuta-Augustina
Pop, Anca Lucia
Cretoiu, Dragos
Varlas, Valentin Nicolae
Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title_full Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title_fullStr Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title_full_unstemmed Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title_short Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug
title_sort hyperthyroidism in pregnancy: the delicate balance between too much or too little antithyroid drug
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396831/
https://www.ncbi.nlm.nih.gov/pubmed/34442037
http://dx.doi.org/10.3390/jcm10163742
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