Fetal and Maternal Outcomes of Gestational Thyrotoxicosis: Single Center Experience, Retrospective Cohort

Year 2020, Volume: 53 Issue: 1, 1 - 5, 31.03.2020

Nazlı Gülsoy Kirnap , Sanem Kayhan

https://doi.org/10.20492/aeahtd.689098

Abstract

Objective: Gestational thyrotoxicosis may lead to adverse maternal and fetal events. In this study, the aim was to compare the gestational thyrotoxicosis cases with the control group in terms of their differential diagnoses, clinical observation and gestational follow-up outcomes.
Materials and Methods: Pregnant patients with subclinical or overt thyrotoxicosis who were followed up in endocrinology outpatient clinic between December 2009-September 2019 were included in the study. Patients were grouped according to the diagnosis of gestational transient thyrotoxicosis (GTT), Graves’ disease, toxic nodular goiter (TNG), and intra-group comparisons and comparisons with the control group were made in terms of the presence of maternal and fetal pregnancy complications during the gestational period, delivery week, and infant birthweight.
Results: A total of 115 patients were divided into GTT group, which had 50 patients, Graves’ group, which had 14 patients, TNG group, which had 1 patient, and control group, which had 50 patients. The prevalence of hyperemesis gravidarum was the highest in GTT group, with 40%. Eclampsia was found in 2 (14.2%) of the pregnant women with Graves’ disease and was not found in other groups (p=0.01). Neonatal death was found in 3 (21.4%) of the pregnant women with Graves’ disease, and 1 (2%) of the pregnant women with GTT (p=0.01). There was a significant positive correlation between delivery week and TSH (p=0.001, r:0.64), and a significant negative correlation withft3(p=0.04 r:-0.3). A significant positive correlation was detected between infant birthweight and TSH and delivery week (p=0.03 r:0.32 and p<0.001 r:0.41, respectively).
Conclusion: Gestational transient thyrotoxicosis does not affect infant birthweight and perinatal complications, whereas the prevalence of low infant birthweight and maternal eclampsia is higher in Graves’ disease.

Keywords

Gestational transient thyrotoxicosis, low birthweight, , perinatal complications

Supporting Institution

Çalışma Başkent Üniversitesi Tıp Fakültesi elektronik bilgi sistemi tarama verilerinden oluşmaktadır. Çalışmada başka kurum katkısı ve maliyet desteği yoktur

Project Number

KA19/428

Thanks

Başkent Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğine teşekkür ederiz

References

• 1-Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238-49.
• 2-Amino N, Kuro R, Tanizawa O, et al. Changes of serum anti-thyroid antibodies during and after pregnancy in autoimmune thyroid diseases. Clin Exp Immunol. 1978;31(1):30-7.
• 3-Glinoer D, de Nayer P, Bourdoux P, et al. Regulation of maternal thyroid during pregnancy. JCEM. 1990;71(2):276-87.
• 4-Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endoc Rev. 2010;31(5):702-55.
• 5-Lo JC, Rivkees SA, Chandra M, Gonzalez JR, Korelitz JJ, Kuzniewicz MW. Gestational thyrotoxicosis, antithyroid drug use and neonatal outcomes within an integrated healthcare delivery system. Thyroid. 2015;25(6):698-705.
• 6-Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol. 1989;160(1):63-70.
• 7-De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. JCEM. 2012;97(8):2543-65.
• 8-Yeo CP, Khoo DH, Eng PH, Tan HK, Yo SL, Jacob E. Prevalence of gestational thyrotoxicosis in Asian women evaluated in the 8th to 14th weeks of pregnancy: correlations with total and free beta human chorionic gonadotrophin. Clin Endocrinol. 2001;55(3):391-8.
• 9-Golberg D, Szilagyi A, Graves L. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstet Gynecol. 2007;110(3):695-703.
• 10-Laurberg P, Cerqueira C, Ovesen L, et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24(1):13-27.
• 11-Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid. 1995;5(5):425-34.
• 12-Lockwood CM, Grenache DG, Gronowski AM. Serum human chorionic gonadotropin concentrations greater than 400,000 IU/L are invariably associated with suppressed serum thyrotropin concentrations. Thyroid. 2009;19(8):863-8.
• 13-Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol. 1994;84(6):946-9.
• 14-Laurberg P, Berman DC, Bulow Pedersen I, Andersen S, Carle A. Incidence and clinical presentation of moderate to severe graves' orbitopathy in a Danish population before and after iodine fortification of salt. JCEM. 2012;97(7):2325-32.
• 15-McNab T, Ginsberg J. Use of anti-thyroid drugs in euthyroid pregnant women with previous Graves' disease. Clin Invest Medicine Med. 2005;28(3):127-31.
• 16-Smith C, Thomsett M, Choong C, Rodda C, McIntyre HD, Cotterill AM. Congenital thyrotoxicosis in premature infants. Clin Endocrinol. 2001;54(3):371-6.