Hyperthyroidism in pregnancy

Cooper, David S; Laurberg, Peter

doi:10.1016/s2213-8587(13)70086-x

Cited by 310Thyroid Disorders and TreatmentsOphthalmology and Eye DisordersThyroid and Parathyroid Surgery

Hyperthyroidism in pregnancy

Cooper, David S, Laurberg, Peter·2013·The Lancet Diabetes & Endocrinology

DOI 10.1016/s2213-8587(13)70086-x

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Abstract

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. Approximately one to two cases of gestational hyperthyroidism occur per 1000 pregnancies. Identification of hyperthyroidism in a pregnant woman is important because adverse outcomes can occur in both the mother and the offspring. Graves' disease, which is autoimmune in nature, is the usual cause; but hyperthyroidism in pregnancy can be caused by any type of hyperthyroidism--eg, toxic multinodular goitre or solitary autonomously functioning nodule. Gestational transient thyrotoxicosis is typically reported in women with hyperemesis gravidarum, and is mediated by high circulating concentrations of human chorionic gonadotropin. Post-partum thyroiditis occurs in 5-10% of women, and many of those affected ultimately develop permanent hypothyroidism. Antithyroid drug treatment of hyperthyroidism in pregnant women is controversial because the usual drugs--methimazole or carbimazole--are occasionally teratogenic; and the alternative--propylthiouracil--can be hepatotoxic. Fetal hyperthyroidism can be life-threatening, and needs to be recognised as soon as possible so that treatment of the fetus with antithyroid drugs via the mother can be initiated. In this Review, we discuss physiological and pathophysiological changes in thyroid hormone economy in pregnancy, the diagnosis and management of hyperthyroidism during pregnancy, severe life-threatening thyrotoxicosis in pregnancy, neonatal thyrotoxicosis, and post-partum hyperthyroidism.

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The increase in serum human chorionic gonadotropin concentration can lead to low serum TSH concentrations in up to 18% of pregnant women during early pregnancy, most of whom will have normal free T4 concentrations.
“The increase in serum human chorionic gonadotropin concentration can lead to low serum TSH concentrations in up to 18% of pregnant women during early pregnancy, most of whom will have normal free T 4 concentrations [19] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [19]
Pregnancy and advanced age may confound the diagnosis of subclinical hyperthyroidism.
“Pregnancy and advanced age may confound the diagnosis of SHyper [19,20] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [19]
Excluding patients with TSH suppression or gestational thyrotoxicosis during the first trimester, Graves' disease is the most common cause of hyperthyroidism during pregnancy; nodular thyroid disease is less common.
“Excluding patients with TSH suppression or gestational thyrotoxicosis during the first trimester, GD is the most common cause of hyperthyroidism during pregnancy (431,444); nodular thyroid disease is less common.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [431]
In early pregnancy, changes in thyroid function can mimic biochemical hyperthyroidism that does not require therapy.
“In early pregnancy, these changes can mimic biochemical hyperthyroidism that does not require therapy (431).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [431]
Beta-adrenergic blocking agents have been studied extensively for treating hypertension in pregnancy, and no major side effects have been detected, although fetal growth restriction has been associated with prolonged use of especially atenolol.
“These agents have been studied extensively when used for treating hypertension in pregnancy, and no major side effects have been detected, although fetal growth restriction has been associated with the prolonged use of especially atenolol (431,471).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [431]

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2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
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Global epidemiology of hyperthyroidism and hypothyroidism
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Graves’ disease
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The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism
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The Impact of Obesity on Thyroid Autoimmunity and Dysfunction: A Systematic Review and Meta-Analysis
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Hyperthyroidism
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Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism
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Hyperthyroidism in the pregnant woman: Maternal and fetal aspects
Moleti, M., Mauro, M. D., Sturniolo, G., Russo, M., & Vermiglio, F. (2019) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2019.100190 · Cited by 74 · see citing works
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Congenital Hypothyroidism in Preterm Newborns – The Challenges of Diagnostics and Treatment: A Review
Kłosińska, M. J., Kaczyńska, A., & Beń‐Skowronek, I. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.860862 · Cited by 64 · see citing works
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Authors: Cooper, D. S., & Laurberg, P.
Affiliations: Johns Hopkins University (US)
Aalborg University Hospital (DK)
Corresponding author: Cooper, David S
ORCID: Cooper, David S
Venue: The Lancet Diabetes & Endocrinology
Publisher: Elsevier BV
Published: 2013-11
Volume: 1
Issue: 3
Pages: 238-249
ISSN: 2213-8587 (ISSN-L)
DOI: 10.1016/s2213-8587(13)70086-x
OpenAlex: W2134210256
Cited by: 310
References: 120
Citations by year: 2026: 14 · 2025: 21 · 2024: 23 · 2023: 25 · 2022: 50 · 2021: 32 · 2020: 32 · 2019: 33 · 2018: 22 · 2017: 21 · 2016: 19 · 2015: 12 · 2014: 6
FWCI: 1.82
Type: journal article
Language: en
Open access: closed
Locations: The Lancet Diabetes & Endocrinology (publishedVersion)
PubMed (publishedVersion)
VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: hyperthyroidism in pregnancy, gestational hyperthyroidism, Graves' disease, hyperemesis gravidarum, human chorionic gonadotropin, postpartum thyroiditis, antithyroid drugs in pregnancy, methimazole, carbimazole, propylthiouracil, fetal hyperthyroidism, neonatal thyrotoxicosis, toxic multinodular goiter, autonomously functioning thyroid nodules
MeSH terms: Female, Fetal Diseases, Graves Disease, Humans, Hyperthyroidism, Infant, Newborn, Pregnancy, Antithyroid Agents, Thyroid Hormones, Thyrotropin

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