Review Article: Present Perspectives of Hyperthyroidism during Pregnancy

Authors

  • Meena S. Farman Department of Biology, College of Science, University of Anbar, Anbar, IRAQ.
  • Rana Hazim Hamoode Basic Science Department, Dentistry of College, University of Anbar, Anbar, IRAQ.
  • Dalal A. Sattar Department of Biology, College of Science, Mustansiriyah University, Baghdad, IRAQ.

DOI:

https://doi.org/10.31033/ijrasb.8.3.26

Keywords:

hyperthyroidism, disease occurrence, diagnosis, aetiology

Abstract

Around 80% of the hyperthyroidism cases of women of childbearing age are inflammatory due to Graves' disease. Production and manifestation of other than gestational and early-onset diabetes may be linked to the hormonal modifications in the maternal immune system during birth. Therefore, in addition to the hormonal influences, the pregnancy test will be affected by various anatomical modifications or alterations seen in the body during pregnancy. For the health of a woman and the start of her pregnancy, thyroid hormones are very significant. These hormones are critical in early development and play a vital role in continuing the fetus's growth since conception. Women with untreated or inadequately controlled hyperthyroidism are at risk of giving birth problems. Future diseases, particularly those with IUGRTH producing so many fetuses. The treatment of hyperthyroid pregnant people is so tricky, and medical staff involvement is needed to ensure that it's monitored and treated in various ways. Pregnant women are prescribed antithyroid medications, and it is the medication of preference for most pregnant women (ATDs). Although both of these medications are transmitted to the fetus by the mother's bloodstream, they are significantly efficient in the treatment of maternal hyperthyroidism. Still, they need caution throughout the second half of pregnancy because of the possibility of fetopathy. Except in the first trimesters from weeks 6 to 10 weeks, the most prevalent adverse effect is abnormalities in the fetal; even with that as a caveat, the incidence of birth defects is high during the first trimester with the help of ATDs. The treatment of hyperthyroidism during pregnancy goes into four issues that are currently of major importance to obstetricians: its aetiology, disease occurrence, proper detection, under treatment, complications, and actual or a missed diagnosis and intervention, and finally, the method of dealing with the problem.

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References

Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet. 2012;379(9821): 1155–1166.

Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.

De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endo- crine Society clinical practice guideline. J ClinEndocrinolMetab. 2012;97(8):2543–2565.

Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and manage- ment of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–1125.

Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238–249.

Carlé A, Pedersen IB, Knudsen N, et al. Epidemiology of subtypes of hyperthyroidism in Iraq: a population-based study. Eur J Endocrinol. 2011;164(5):801–809.

Abeillon-du Payrat J, Chikh K, Bossard N, Bretones P, Gaucherand P, Claris O, Charrie A, Raverot V, Orgiazzi J, Borson-Chazot F, Bournaud C. Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism. Eur J Endocrinol. 2014;171:451–60.

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.

King JR, Lachica R, Lee RH, et al. Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review. Obstet Gynecol Surv 2016;71:675-85.

Andersen SL, Olsen J, Carlé A, Laurberg P. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J Clin Endocrinol Metab. 2015;100(3):1164–1171.

Banige MEC, Biran V, Desfrere L, Champion V, Benachi A, Ville Y, Dommergues M, Jarrau PH, Mokhtari M, Boithias C, Brioude F, Mandelbrot L, Ceccaldi PF, Mitanchez D, Polak M, Luton D. Study of the factors leading to fetal and neonatal Dysthyroidism in children of patients with graves disease. Journal of endocrine. Society. 2017;1:751–61.

Song R, Lin H, Chen Y, Zhang X, Feng W. Effects of methimazole and propylthiouracil exposure during pregnancy on the risk of neonatal congenital malformations: a meta-analysis. PLoS One. 2017;12:e0180108.

Amino N, Tanizawa O, Mori H, et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves’ disease. J ClinEndocrinolMetab. 1982;55(1):108–112.

Andersen SL, Olsen J, Carle A, et al. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J ClinEndocrinolMetab 2015;100:1164-71.

Bliddal S, Feldt-Rasmussen U, Boas M, et al. Gestational age-specific reference ranges from different laboratories misclassify pregnant women’s thyroid status: comparison of two longitudinal prospective cohort studies. Eur J Endocrinol. 2013;170(2):329–339.

Laurberg P, Andersen SL, Hindersson P, Nohr EA, Olsen J. Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy: a study within the Danish National Birth Cohort. J Clin Endocrinol Metab. 2016;101(6):2484–2492.

Hesarghatta Shyamasunder A, Abraham P. Measuring TSH receptor antibody to influence treatment choices in Graves’ disease. Clin Endocrinol. 2017;86:652–7.

Gudernatsch JF. Feeding experiments on tadpoles. Arch Entwicklungs- mech Org. 1912;35(3):457–483.

Colicchia M, Campagnolo L, Baldini E, Ulisse S, Valensise H, Moretti C. Molecular basis of thyrotropin and thyroid hormone action during implantation and early development. Hum Reprod Update. 2014; 20(6):884–904.

Vissenberg R, Manders VD, Mastenbroek S, et al. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update. 2015;21(3):378–387.

Andersen SL, Olsen J, Wu CS, Laurberg P. Spontaneous abortion, stillbirth and hyperthyroidism: a Danish population-based study. Eur Thyroid J. 2014;3(3):164–172.

Gianetti E, Russo L, Orlandi F, Chiovato L, Giusti M, Benvenga S, Moleti M, VermiglioF, Macchia PE, Vitale M, Regalbuto C, Centanni M, Martino E, Vitti P, Tonacchera M. Pregnancy outcome in women treated with methimazole or propylthiouracil during pregnancy. J EndocrinolInvestig. 2015;38:977–85.

Andersen SL, Olsen J, Carle A, Laurberg P. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J ClinEndocrinolMetab. 2015;100:1164–71.

Kahaly GJ. Bioassays for TSH receptor antibodies: quo Vadis? Eur Thyroid J. 2015;4:3–5.

Munoz JL, Kessler AA, Felig P, Curtis J, Evans MI. Sequential amniotic fluid thyroid hormone changes correlate with goiter shrinkage following in utero thyroxine therapy. Fetal DiagnTher. 2016;39:222–7.

Nelson SM, Haig C, McConnachie A, et al. Maternal thyroid function and child educational attainment: prospective cohort study. BMJ 2018;360:k452.

Andersen SL, Olsen J, Laurberg P. Foetal programming by maternal thyroid disease. ClinEndocrinol (Oxf). 2015;83(6):751–758.

Andersen SL, Laurberg P, Wu CS, Olsen J. Maternal thyroid dysfunc- tion and risk of seizure in the child: a Danish nationwide cohort study. J Pregnancy. 2013;2013:Article ID 636705.

Andersen SL, Laurberg P, Wu CS, Olsen J. Attention deficit hyperactiv- ity disorder and autism spectrum disorder in children born to mothers with thyroid dysfunction: a Danish nationwide cohort study. BJOG. 2014;121(11):1365–1374.

Seo GH, Kim TH, Chung JH. Antithyroid Drugs and Congenital Malformations: A Nationwide Korean Cohort Study. Ann Intern Med 2018;168:405-13.

Fraenkel M, Shafat T, Cahn A, et al. Low thyroid-stimulating hormone and its persistence beyond the first trimester of pregnancy. Int J GynaecolObstet 2018;142:270-6.

Aubry G, Pontvianne M, Chesnais M, Weingertner AS, Guerra F, Favre R. Prenatal diagnosis of fetal Goitrous hypothyroidism in a Euthyroid mother: a management challenge. J Ultrasound Med. 2017;36(11):2387–92.

Bucci I, Giuliani C, Napolitano G. Thyroid-Stimulating Hormone Receptor Antibodies in Pregnancy: Clinical Relevance. Front Endocrinol (Lausanne) 2017;8:137.

Andersen SL, Olsen J, Laurberg P. Antithyroid drug side effects in the population and in pregnancy. J ClinEndocrinolMetab. 2016; 101(4):1606–1614.

American College of O, Gynecologists. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol. 2015;125:996–1005.

Andersen SL, Olsen J, Laurberg P. Foetal programming by maternal thyroid disease. ClinEndocrinol. 2015;83:751–8.

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;25:698–705.

Bowman P, Osborne NJ, Sturley R, Vaidya B. Carbimazoleembry- opathy: implications for the choice of antithyroid drugs in pregnancy. QJM. 2012;105(2):189–193.

Andersen SL, Laurberg P. Antithyroid drugs and congenital heart defects: ventricular septal defect is part of the methimazole/carbimazoleembryopathy. Eur J Endocrinol. 2014;171(5):C1–C3.

Yoshihara A, Noh J, Yamaguchi T, et al. Treatment of Graves’ dis- ease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J ClinEndocrinolMetab. 2012; 97(7):2396–2403.

Andersen SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J ClinEndocrinolMetab. 2013;98(11):4373–4381.

Andersen SL, Olsen J, Wu CS, Laurberg P. Severity of birth defects after propylthiouracil exposure in early pregnancy. Thyroid. 2014;24(10):1533–1540.

King JR, Lachica R, Lee RH, Montoro M, Mestman J. Diagnosis and Management of Hyperthyroidism in pregnancy: a review. ObstetGynecolSurv. 2016;71:675–85.

Glinoer D, Cooper DS. The propylthiouracil dilemma. CurrOpinEndocrinol Diabetes Obes. 2012;19(5):402–407.

Laurberg P, Andersen SL. Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?Eur J Endocrinol. 2014;171(1):R13–R20.

Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and fetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol. 2009;160(1):1–8.

Korevaar TIM, de Rijke YB, Chaker L, et al. Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors. Thyroid. 2017;27(3):440-450. doi:10.1089/thy.2016.0527

Laurberg P, Andersen S, Karmisholt J. Antithyroid drug therapy of Graves’ hyperthyroidism: realistic goals and focus on evidence. Expert Rev EndocrinolMetab. 2006;1(1):91–102.

Bliddal S, Rasmussen AK, Sundberg K, Brocks V, Feldt-Rasmussen U. Antithyroid drug-induced fetal goitrous hypothyroidism. Nat Rev Endocrinol. 2011;7(7):396–406.

Korevaar TIM, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. The Lancet Diabetes & Endocrinology. 2016;4(1):35-43. doi:10.1016/S2213-8587(15)00327-7

van der Kaay DC, Wasserman JD, et al. Management of Neonates Born to Mothers With Graves' Disease. Pediatrics 2016;137.

Banigé M, Polak M, Luton D, et al. Prediction of Neonatal Hyperthyroidism. J Pediatr 2018;197:249-254.e1.

vanDijk MM, Smits IH, et al. Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review. Thyroid 2018;28:257-64.

Kiefer FW, Klebermass-Schrehof K, Steiner M, et al. Fetal/Neonatal Thyrotoxicosis in a Newborn From a Hypothyroid Woman With Hashimoto Thyroiditis. J ClinEndocrinolMetab 2017;102:6-9.

Léger J. Management of Fetal and Neonatal Graves' Disease. Horm Res Paediatr 2017;87:1-6.

American College of Obstetricians and Gynecologists. Practice Bulletin No 148: Thyroid disease in pregnancy. ObstetGynecol 2015;125:996-1005.

F. Azizi, L. Mehran, A. Amouzegar et al., “Establishment of the trimester-specific reference range for free thyroxine index,” Thyroid, vol. 23, no. 3, pp. 354–359, 2013.

Joshi K, Zacharin M. Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies. J PediatrEndocrinolMetab 2018;31:577-80.

Aubry G, Pontvianne M, Chesnais M, et al. Prenatal Diagnosis of Fetal Goitrous Hypothyroidism in a Euthyroid Mother: A Management Challenge. J Ultrasound Med 2017;36:2387-92.

Nguyen CT, Sasso EB, Barton L, et al. Graves' hyperthyroidism in pregnancy: a clinical review. Clin Diabetes Endocrinol 2018;4:4.

Andersen SL, Olsen J, Laurberg P. Foetal programming by maternal thyroid disease. ClinEndocrinol (Oxf) 2015;83:751-8.

Munoz JL, Kessler AA, Felig P, et al. Sequential Amniotic Fluid Thyroid Hormone Changes Correlate with Goiter Shrinkage following in utero Thyroxine Therapy. Fetal DiagnTher 2016;39:222-7.

Andersen SL, Olsen J, Laurberg P. Antithyroid Drug Side Effects in the Population and in Pregnancy. J ClinEndocrinolMetab 2016;101:1606-14.

Akamizu T. Thyroid Storm: A Japanese Perspective. Thyroid 2018;28:32-40.

Kinomoto-Kondo S, Umehara N, Sato S, et al. The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study. Arch GynecolObstet 2017;295:87-93.

Fiaschi L, Nelson-Piercy C, Tata LJ. Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies. Hum Reprod 2016;31:1675-84.

Donnelly MA, Wood C, Casey B, et al. Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy. ObstetGynecol 2015;125:1059-62.

Diana T, Krause J, Olivo PD, et al. Prevalence and clinical relevance of thyroid stimulating hormone receptor-blocking antibodies in autoimmune thyroid disease. ClinExpImmunol 2017;189:304-9.

Giuliani C, Saji M, Bucci I, et al. Bioassays for TSH Receptor Autoantibodies, from FRTL-5 Cells to TSH Receptor-LH/CG Receptor Chimeras: The Contribution of Leonard D. Kohn. Front Endocrinol (Lausanne) 2016;7:103.

Banigé M, Estellat C, Biran V, et al. Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease. J EndocrSoc 2017;1:751-61.

Bucci I, Giuliani C, Napolitano G. Thyroid-Stimulating Hormone Receptor Antibodies in Pregnancy: Clinical Relevance. Front Endocrinol (Lausanne) 2017;8:137.

Korevaar, Tim I. M.; de Rijke, Yolanda B.; Chaker, Layal; Medici, Marco; Jaddoe, Vincent W. V.; Steegers, Eric A. P.; Visser, Theo J.; Peeters, Robin P. (March 2017). "Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors". Thyroid. 27 (3): 440–450.

Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017;27:315-89.

Nguyen CT, Mestman JH. A look at Graves’ hyperthyroidism in pregnancy. Ann Thyroid. 2018;3:28-28 doi:10.21037/aot.2018.10.02

Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017;13(10):610-622. doi:10.1038/nrendo.2017.93

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Published

2021-05-31

How to Cite

Meena S. Farman, Rana Hazim Hamoode, & Dalal A. Sattar. (2021). Review Article: Present Perspectives of Hyperthyroidism during Pregnancy. International Journal for Research in Applied Sciences and Biotechnology, 8(3), 212–221. https://doi.org/10.31033/ijrasb.8.3.26

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