An endocrine society clinical practice guideline clinical guidelines the endocrine societys the endocrine society 8401 connecticut avenue, suite 900 chevy chase, md 20815 301. Managing thyroid disease during pregnancy, new ata guidelines. Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. Overt hyperthyroidism in pregnancy requires treatment with suppressive thyrostatic agents to ensure maternal euthyroid status. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Javert3 reported an incidence of toxemia of pregnancy. Identification of hyperthyroidism in a pregnant woman is important because adverse.
Overtreatment of maternal hyperthyroidism with thionamide antithyroid drugs atds can cause fetal goiter and primary hypothyroidism. Establishing the correct diagnosis and effectively managing graves hyperthyroidism in pregnancy remains a challenge for physicians. A new diagnosis of hyperthyroidism is uncommon in early pregnancy, as untreated disease is associated with reduced fertility. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy. Your healthcare provider will ask about your symptoms and what medicines you take. Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, and induced thyroxine overdose. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. May 06, 2015 hyperthyroidism during pregnancy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid. In women who have underlying hyperthyroidism, in particular graves disease, uncontrolled disease may have detrimental effects on the pregnancy for both more and child. Treatment of hyperthyroidism in pregnancy and birth. No controlled trials of management have been conducted, but consensus guidelines have recently been.
This is generally caused by overproduction or release of thyroid hormone by the thyroid gland. He will ask about your medical history and if anyone in your family has thyroid disease. Both of these drugs cross the placenta and can potentially impair the babys thyroid function and cause fetal goiter. Thyrotoxicosis in pregnancy fetal and maternal medicine. Thyroid disease and pregnancy, thyroid research grants research grant to study the action of tregulatory cells in thyroidantibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association. 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. These guidelines cover diagnostic and therapeutic aspects of thyroid nodular disease but not thyroid cancer management. Thyroid diseases affect up to 5% of all pregnancies. Sep 19, 2016 incidence of hyperthyroidism in pregnancy. Thyroid disorders in pregnancy article pdf available in the journal of the association of physicians of india 59 supplsuppl. If performed after pregnancy, radioactive iodine will contraindicate lactation requires avoiding close contact with the infant for a period of time.
Hyperthyroidism in pregnancy american thyroid association. Recently, during a panel dis cussion on this subject, sponsored by the american thyroid association,1 there was no uniformity of opinion, and the three types of treatment antithyroid medication, antithyroid medication plus thyroid therapy, and surgery were defended. Hyperthyroidism in pregnancy aftercare instructions. The pregnancy uncontrolled hyperthyroidism is accompanied by a high incidence of abortions, premature births and toxemias. Graves disease is the predominant type of overt hyperthyroidism in women of reproductive age and thereby also the main type of overt hyperthyroidism in pregnancy. Mmi and ptu are the main antithyroid drugs for the treatment of hyperthyroidism. Hyperthyroidism during pregnancy find out what an overactive thyroid means for you and your baby. Mar 04, 2020 newonset graves hyperthyroidism is estimated to occur in about 0. Feb 03, 2020 your healthcare provider will ask about your symptoms and what medicines you take.
Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to. Hyperthyroidism and pregnancy endocrine system home page. The use of antithyroid drugs in pregnancy and lactation. Endocrine disorders in pregnancy pdf free download. Approximately one to two cases of gestational hyperthyroidism occur per pregnancies. Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. The paper will discuss preconception counseling, etiologies. Graves disease, which is autoimmune in nature, is the usual cause. Introduction thyroid disorder is a general term representing several different diseases involving thyroid hormones and the thyroid gland. You will have blood tests to check your thyroid hormone level. Some symptoms of hyperthyroidism or hypothyroidism are easier to spot and may prompt your doctor to test you for these thyroid diseases. The 2017 ata guidelines recommends ptu for the treatment of hyperthyroidism in early pregnancy then switching it mmi in the 2nd trimester. Although infrequent, identification of hyperthyroidism in a pregnant woman.
Thyrotoxicosis of pregnancy can present unique diagnostic challenges and, if untreated, is associated with increased risks of adverse maternal, fetal, and neonatal complications. Various problems may arise in the management of a pregnant patient with hyperthyroidism see scenario box. Thyroid problems can be hard to diagnose in pregnancy due to higher levels of thyroid hormones and other symptoms that occur in both pregnancy and thyroid disorders. Hyperthyroidism is more common in the adolescent age group with higher. Methimazole a tapazole or propylthiouracil ptu are the atds available in the united states for the treatment of hyperthyroidism see hyperthyroidism brochure.
If you continue browsing the site, you agree to the use of cookies on this website. Paul hospital, thessaloniki, greece abstract the most common thyroid diseases during pregnancy are hyper and hypothyroidism and their. Feb 03, 2020 care guide for hyperthyroidism in pregnancy aftercare instructions. Mar 22, 2008 most pregnant women with hyperthyroidism are known to have had thyroid disease before the onset of gestation and will already be receiving treatment. Hyperthyroidism in pregnancy what you need to know. The best way to avoid the complications of hyperthyroidism in pregnancy is to be sure the disease is. Discuss definitive management options prior to pregnancy. Coping with an overactive thyroid and hyperthyroidism symptoms. Radioactive iodine should be completed at least 6 months prior to pregnancy. Symptoms of hyperthyroidism common in pregnancy heat intolerance. Oct 16, 2015 graves disease, the most common cause of thyrotoxicosis in pregnancy, is an autoimmune condition characterized by production of thyroidstimulating immunoglobulin tsi and thyroidstimulating hormone binding inhibitory immunoglobulin tbii these two antibodies facilitate the thyroidstimulating hormone tsh receptor in the mediation of thyroid stimulation and inhibition, respectively. Hyperthyroidism in pregnancy is usually caused by graves disease and occurs in 1 to 4 of every 1,000 pregnancies in the united states. Overall, the most common cause 8085% of maternal hyperthyroidism during pregnancy is graves disease see graves disease brochure and occurs in 1 in 1500 pregnant patients. A wholebody approach to hyperthyroidism treatment can address not only the symptoms of hyperthyroidism, but also tackle the root cause and underlying problems.
Outline treatment of hyperthyroidism during pregnancy. Pdf file for saving and printing, 618 kb hyperthyroidism a mild risk of neonatal hyperthyroidism follows radioactive iodine therapy for graves disease prior to pregnancy graves disease is caused by the patient making an antibody called trab that attacks and turns on the thyroid, making it overactive. Most pregnant women with hyperthyroidism are known to have had thyroid disease before the onset of gestation and will already be receiving treatment. This is a type of autoimmune disease in which the bodys immune system attacks its own healthy thyroid gland. Identification of hyperthyroidism in a pregnant woman is important because. Hypothyroidism and hyperthyroidism during pregnancy. Pdf maternal hypertiroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. The best way to avoid the complications of hyperthyroidism in pregnancy is to be sure the disease is controlled before conception occurs. Hypothyroidism in pregnancy weiping teng, zhongyan shan, komal patilsisodia, david s cooper hypothyroidism is the most common pregnancy related thyroid disorder, a. This document was prepared as a collaborative effort between the american association of clinical endocrinologists aace, american college of endocrinology ace and associazione medici endocrinologi ame. Thyroid disease in pregnancy american family physician. Guidelines of the american thyroid association for the. Karras,2 nikolaos pontikides2 1cultural and educational center g.
The most common complication of hyperthyroidism in pregnant mothers is preeclampsia. Diagnosis and treatment of hyperthyroidism in pregnancy. Mar 20, 2008 various problems may arise in the management of a pregnant patient with hyperthyroidism see scenario box. Treatment of hyperthyroidism in pregnancy and birth defects. Hyperthyroidism during pregnancy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is. This being the case, current guidelines recommend the use of the. On the other hand, transient central hypothyroidism may be seen in infants whose mothers had poorly controlled hyperthyroidism during pregnancy, presumably due to suppression of the fetal pituitarythyroid axis. Pdf management of hyperthyroidism in pregnancy researchgate. Radioiodine is not advisable to treat hyperthyroidism during pregnancy, according to the american thyroid association, since it crosses the placenta and is taken up by the babys thyroid gland. Thyroid hormone plays a critical role dur ing pregnancy both in the development of a. Graves disease represents the most common cause of maternal hyperthyroidism during pregnancy only 0. Propylthiouracil ptu is the treatment of choice in any woman with graves disease planning pregnancy or in the first trimester as carbimazole is associated with a rare embryopathy.
Clinical hyperthyroidism is not uncommon in pregnancy, with a reported prevalence of 0. A number of important issues gerasimos krassas,1 spyridon n. Guidelines american association of clinical endocrinologists. Get info on causes, risks, treatments and prevention of hyperthyroidism during pregnancy at. With this disease, your immune system makes antibodies that cause the thyroid to make too much thyroid hormone.
Peter laurberg passed away on june 20, 2016 abstract. Care guide for hyperthyroidism in pregnancy aftercare instructions. Hyperthyroidism refers to a disease in which there is excessive amount of thyroid hormone in the blood. Feb 15, 2014 thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. Methimazole should be started in the second trimester and continued for the remainder of pregnancy. 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. Treatmentof hyperthyroidism dur ing pregnancy remains contro versial. Uncontrolled hyperthyroidism can also complicate the maternal physiology resulting in elevations in heart rate and cardiac output causing life threatening arrhythmias and heart failure.
Discuss options for women with known hyperthyroidism well before planned conception if possible. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is thought to reduce these risks. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the etiology of thyrotoxicosis. Establishing the correct diagnosis and effectively managing. No controlled trials of management have been conducted, but consensus guidelines have recently been published. The clinical presentation, serum thyroid function test results, and serum trab titers can help differentiate the.
Causes and symptoms of hyperthyroidism during pregnancy the most common cause of hyperthyroidism, both in pregnant women and women who are not pregnant, is graves disease. According to recent guidelines, the measurement of the tsh receptor antibodies is not required, if antithyroid drugs have been used because the maternal thyroid. It is best to discuss natural treatment for hyperthyroidism with your doctor or consult a homeopath or naturopath for advice. Transient gestational hyperthyroidism may also occur it has a 23% prevalence in europe but is much higher in south asians. Mmi is preferred in nonpregnant patients because ptu can rarely cause liver problems, but is less preferred in pregnancy due to an increased risk of birth defects. Hyperthyroidism in pregnancy aftercare instructions what. Treatment for hyperthyroidism during pregnancy will depend on your health, age, stage of pregnancy and the size of your thyroid gland.
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