Diagnosis and treatment of hyperthyroidism in pregnancy. Hyperthyroidism the journal of clinical endocrinology. Hyperthyroidism in pregnancy inpatient care what you need. Mar 01, 2016 hyperthyroidism is an excessive concentration of thyroid hormones in tissues causing a characteristic clinical state. Graves disease, which is autoimmune in nature, is the usual cause. Your healthcare provider will ask about your symptoms and what medicines you take. Thyroid dysfunction in pregnancy has consequences for mother and baby. Doctors use antithyroid medications and radioactive. Establishing the correct diagnosis and effectively managing graves hyperthyroidism in pregnancy remains a challenge for physicians. Clinical hyperthyroidism is not uncommon in pregnancy, with a reported prevalence of 0. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism.
These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. Hyperthyroidism caused by overproduction of thyroid hor mones can be treated with antithyroid medications methimazole and propylthiouracil, radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. Dec 01, 2014 thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism. These include understanding indications for treatment, therapeutic options for pregnant women, and goals of antithyroid drug atd therapy. The most common cause of hyperthyroidism in pregnancy is graves disease, which accounts for about 95% of cases thyroid storm can be precipitated by infection, surgery, thromboembolism, preeclampsia, labor, and delivery whatever regimen you select to treat hyperthyroidism of pregnancy, adopt a program of close monitoring of thyroid function. Hyperthyroidism is usually a chronic, even lifelong, disorder. Guidelines of the american thyroid association for the.
The choice of treatment modality for hyperthyroidism caused by overproduction of thyroid hormones depends on the patients age, symptoms. Hyperthyroidism diagnosis and treatment mayo clinic. The treatment of hyperthyroidism during pregnancy is presented here. Thyroid dysfunction during pregnancy and postpartum. Doctors have used radioactive iodine to treat hyperthyroidism for over 60 years. Treatment is necessary if you have hyperthyroidism. With this disease, your immune system makes antibodies that cause the thyroid to make too much thyroid hormone. Hyperthyroidism, also called overactive thyroid, is when the thyroid gland makes more thyroid hormones than your body needs. In most cases, managing hyperthyroidism involves one of the following treatment options. In general, 2 of every pregnancies have been reported to be complicated by hyperthyroidism.
Examples of thyroid disorders that give rise to hyperthyroidism include. How to manage hyperthyroid disease in pregnancy mdedge obgyn. Surgery may be done to remove all or part of your thyroid gland. Overproduction of thyroid hormone causes the systolic blood pressure to increase. Get info on causes, risks, treatments and prevention of hyperthyroidism during pregnancy at. Hyperthyroidism overactive thyroid occurs when your thyroid gland produces too much of the hormone thyroxine. Overt hyperthyroidism in pregnancy requires treatment with suppressive thyrostatic agents to ensure maternal euthyroid status.
The best way to avoid the complications of hyperthyroidism in pregnancy is to be sure the disease is. Hyperthyroidism during pregnancy find out what an overactive thyroid means for you and your baby. Treatments for hyperthyroidism your treatment plan depends. However, your doctor may recommend that you watch out for iodine in your diet because it can cause hyperthyroidism or make it worse. The thyroid is a small, butterflyshaped gland in the front of your neck. The most common cause of hyperthyroidism during pregnancy is graves disease. Hyperthyroidism in pregnancy american thyroid association. Hyperthyroidism in pregnancy inpatient care what you. Pregnant women with graves hyperthyroidism or thyroid nodules should start antithyroid drug treatment or, if already taking this medication, see their doctor about the dose. Graves disease is a complex autoimmune disorder, characterized by autoantibodies that activate the tsh receptor.
Left untreated, hyperthyroidism may lead to heart problems, bone loss, fracture risk. If you have ever been treated for hyperthyroidism, or are currently being treated, see your doctor regularly so that your condition can be monitored. Pregnant women with hyperthyroidism need careful management as some may be at increased risk of fetal loss, preeclampsia, heart failure, premature labour, and having a low birthweight baby various problems may arise in the management of a pregnant patient with hyperthyroidism see scenario box. Hyperthyroidism due to graves disease most often improves as pregnancy advances but. Hyperthyroidism associated with pregnancy may pose a challenging diagnostic and therapeutic dilemma. Hyperthyroidism may be asymptomatic or present with significant symptoms. Hyperthyroidism in pregnancy is usually caused by graves disease and occurs in 1 to 4 of every 1,000 pregnancies in the united states. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body.
Although menstrual irregularity is frequent in women with mild to moderate hyperthyroidism, convincing evidence that fertility is impaired is lacking. Methimazole tapazole or propylthiouracil ptu are the atds available in the united states for the treatment of hyperthyroidism see hyperthyroidism brochure. The best way to avoid the complications of hyperthyroidism in pregnancy is to be sure the disease is controlled before conception occurs. It can be treated with an antithyroid drug, radioactive iodine, or surgery thyroidectomy, in which a portion or all of the thyroid gland is surgically removed. When hyperthyroidism is severe enough to require therapy, antithyroid medications are the treatment of choice, with ptu being preferred in the first trimester. An endocrinologist, a specialist in hormonerelated conditions, can help diagnose and treat hyperthyroidism. Radioactive iodine ablation is the most widely used treatment in the united states. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the etiology of thyrotoxicosis. Treatment for hyperthyroidism during pregnancy will depend on. Medicines or surgery may damage too many thyroid gland cells and cause hypothyroidism too little thyroid hormone.
Managing thyroid disease during pregnancy, new ata guidelines the 2017 guidelines, issued after 6 years of new evidence and experience, offer more targeted recommendations for clinical management of women who have thyroid disease once they become pregnant as well as postpartum. Treatment for hyperthyroidism during pregnancy will depend on your health, age, stage of pregnancy and the size of your thyroid gland. Many of the signs and symptoms of hyperthyroidism may be associated with other conditions. Therefore, hyperthyroidism is documented as a common cause of hypertension. Thyroid storm and hyperthyroidism in pregnancy and during the postpartum period are special circumstances that need careful assessment and treatment. There are a number of hyperthyroidism treatments available. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the. This could cause heart palpitations, nervousness, and osteoporosis bone loss and bone thinning. It is characterised by normal or high thyroid radioactive iodine uptake thyrotoxicosis with hyperthyroidism or true hyperthyroidism. Palmert, md, phd ca, b, a division of endocrinology, the hospital for sick children. Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism.
The best plan for you depends on your symptoms, the cause of your hyperthyroidism, and what treatment option makes you most comfortable. Hyperthyroidism in pregnancy what you need to know. Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems. The most common causes of an excessive production of thyroid hormones are graves. Diagnosis of overactive thyroid and treatment of the underlying cause can relieve symptoms and prevent complications. You will have blood tests to check your thyroid hormone level. Management of neonates born to mothers with graves disease.
However, majority of pregnant women often mistake the signs and symptoms of hyperthyroidism to pregnancy symptoms. Several treatments are available for hyperthyroidism. Patient counseling, surgical considerations, and obstetric management. Once you begin treatment, symptoms of hyperthyroidism should subside and you should start feeling much better. Introduction it is characterised by normal or high thyroid radioactive iodine uptake thyrotoxicosis with hyperthyroidism or true hyperthyroidism. Successful treatment of hyperthyroidism will reverse this condition. Treatment of hyperthyroidism in pregnancy and birth. For women known to have hypothyroidism, an increase in thyroxine dose by 2040% when pregnancy is confirmed usually ensures they remain euthyroid. Feb 03, 2020 your healthcare provider will ask about your symptoms and what medicines you take. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid. Hyperthyroidism occurs when the thyroid makes too much t4, t3, or both. Nonthyroid surgery in the patient with thyroid disease. Apr 10, 2020 hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to the hypermetabolic condition of thyrotoxicosis. High levels of thyroid hormones in your body can be toxic.
It is caused by an overactive thyroid gland during pregnancy. Antithyroid medicines decrease thyroid hormone levels. Both of these drugs cross the placenta and can potentially impair the babys thyroid function and cause fetal goiter. Mar 04, 2020 treatment of all cases of hyperthyroidism during pregnancy new diagnoses or worsening of previously controlled hyperthyroidism antithyroid drugs are the first line for all. Overall, the most common cause of hyperthyroidism in women of childbearing age is graves disease see graves disease brochure, which occurs in 0. Management of thyroid dysfunction during pregnancy and. Pregnancy and fetal development guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum the american thyroid association taskforce on thyroid disease during pregnancy and postpartum alex stagnarogreen chair,1 marcos abalovich,2 erik alexander,3 fereidoun azizi,4 jorge. Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to the hypermetabolic condition of thyrotoxicosis. Due to the physiologic changes in pregnancy, special consideration must be given in accurately diagnosing, monitoring, and treating pregnant patients with hyperthyroidism.
A very common characteristic of hyperthyroidism is widened pulse pressure. There are several important issues to be considered when hyperthyroidism occurs during pregnancy. A thyroidectomy is a minimally invasive surgery that is meant to treat thyroid cancer, goiters, and hyperthyroidism. Pdf radioiodine treatment of hyperthyroidism in a pregnant. Mar 20, 2008 various problems may arise in the management of a pregnant patient with hyperthyroidism see scenario box. Introduction hyperthyroidism is a pathological disorder in which excess thyroid hormone is synthesised and secreted by the thyroid gland.
In refractory cases, potassium iodide may be used in conjunction with mmi. Treatments for hyperthyroidism your treatment plan. Jun 12, 2019 treatment is necessary if you have hyperthyroidism. For the first 1820 weeks of pregnancy, the baby is. Thyrotoxicosis of pregnancy can present unique diagnostic challenges and, if untreated, is associated with increased risks of adverse maternal, fetal, and neonatal complications. Aug 27, 2016 thyroid storm and hyperthyroidism in pregnancy and during the postpartum period are special circumstances that need careful assessment and treatment. Radioiodine is contraindicated because of the risk that fetal hypothyroidism could be induced. In women who have underlying hyperthyroidism, in particular graves disease, uncontrolled disease may have detrimental effects on the pregnancy for both more and child. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease. Most patients with hyperthyroidism have an enlarged thyroid gland goiter, but characteristics of the enlargement vary. Your goal before getting pregnant is to stabilize your thyroid and reproductive hormones to regulate your menstruation and increase your chances of getting pregnant treatment.
Feb 03, 2020 treatment for hyperthyroidism during pregnancy may carry certain risks for you and your child. Hyperthyroidism is a pathological disorder in which excess thyroid hormone is synthesised and secreted by the thyroid gland. In the united states, the overall prevalence of hyperthyroidism is 1. Maternal hyperthyroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods.
Its generally considered safe, and it is used to treat more than 70% of adults with hyperthyroidism. In addition to other usual causes of hyperthyroidism see hyperthyroidism brochure, very high levels of hcg. Managing thyroid disease during pregnancy, new ata guidelines. Treatment for hyperthyroidism during pregnancy may carry certain risks for you and your child. Hyperthyroidism in pregnancy what is the interaction between the thyroid function of the mother and the baby. Some of the symptoms of hyperthyroidism include nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, trouble sleeping, thinning of the skin, fine brittle hair, and muscular weaknessespecially in the upper arms and thighs. The need for treatment of asymptomatic infants with biochemical hyperthyroidism. Hyperthyroidism, excess production of thyroid hormone by the thyroid gland. This treatment may cause thyroid activity to slow enough to be considered underactive hypothyroidism, and you may eventually need to take medication every day to replace thyroxine. He will ask about your medical history and if anyone in your family has thyroid disease. The most common forms of hyperthyroidism include diffuse toxic goiter graves disease, toxic multinodular goiter plummer disease, and toxic adenoma. Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. The american thyroid association ata has published new guidelines that cover most aspect of thyroid function and dysfunction during pregnancy and the postpartum period.