Hyperthyroidism and pregnancy

doi:10.1136/bmj.39462.709005.AE

BMJ 2008;336:663-667 (22 March), doi:10.1136/bmj.39462.709005.AE

Practice

Pregnancy Plus

Hyperthyroidism and pregnancy

Helen Marx, registrar in obstetrics and gynaecology ¹, Pina Amin, consultant obstetrician ², John H Lazarus, professor of clinical endocrinology, and honorary consultant physician ¹

¹ Department of Obstetrics, University Hospital of Wales, Cardiff CF14 4XN , ² Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff

Correspondence to: J H Lazarus lazarus@cf.ac.uk

Pregnant women with hyperthyroidism need careful managementas some may be at increased risk of fetal loss, pre-eclampsia,heart failure, premature labour, and having a low birthweightbaby

The first 150 words of the full text of this article appear below.

Various problems may arise in the management of a pregnant patientwith hyperthyroidism (see scenario box).¹ This article willexplore the problems in relation to the prevalence of hyperthyroidismin pregnancy, therapeutic issues, pregnancy planning, and clinicalmanagement. No controlled trials of management have been conducted,but consensus guidelines have recently been published.²

A 35 year old woman develops Graves’ hyperthyroidism(the commonest cause of hyperthyroidism) four months after thebirth of her second child. She receives treatment with antithyroiddrugs for six months. In her third pregnancy she complains ofpalpitations, excessive sweating, and heat intolerance at 16weeks’ gestation. Although she experienced these symptomsin previous pregnancies, the current symptoms are much worse.

Sheis found to be severely hyperthyroid, with raised concentrationsof serum free thyroxine (51.7 pmol/l (normal range 9.8-23.1pmol/l) and free triiodothyronine (19.9 pmol/l (3.5-6.5 pmol/l))and with suppressed concentrations of thyrotrophin (thyroidstimulating . . . [Full text of this article]