Thyrotoxicosis and heart failure that complicate pregnancy
Section snippets
Material and methods
The pregnant women who are described in this report had uncontrolled thyrotoxicosis that was further complicated by congestive heart failure. They were admitted to the obstetrics service at Parkland Hospital from 1974 through 2001. The diagnosis of Graves' disease was made clinically with laboratory confirmation with the standard criteria.9., 10., 13. All of the women had a diffuse toxic goiter and other variable findings that included peripheral tremor, resting tachycardia, weight loss,
Results
During the 28-year study period, slightly over 300,000 women were delivered at our institution. The recognized incidence of overt thyrotoxicosis averaged approximately 1 in 1500 pregnancies, as determined for three epochs: 1:2000 for approximately 120,000 women who were delivered from 1974 through 19859; 1:1500 for approximately 125,000 women who were delivered from 1991 through 1999; and 1:1000 for 11,000 women who underwent serum thyrotropin screening from 2000 through 2001. From all of
Comment
The incidence of Graves' thyrotoxicosis was approximately 1 in 1700 deliveries during the 28-year period under study. A review of the clinical course of our women with hyperthyroid allows us to make a number of clinical observations. First, we found that 9% of pregnant women with Graves' disease had heart failure. All of these 13 women were untreated and thus were overtly thyrotoxic because they had no medical care during their pregnancy or they were noncompliant with antithyroid therapy. The
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2019, Endocrinology and Metabolism Clinics of North AmericaCitation Excerpt :A 28-year retrospective study of pregnancies complicated by controlled or uncontrolled hyperthyroidism compared with age-matched and parity-matched controls found intrauterine growth restriction, placental abruption, preterm labor/birth, low birth weight, and stillbirth were increased in uncontrolled hyperthyroidism.6 Severe preeclampsia and heart failure may also occur,7,8 and thyroid storm has been reported. Therefore, appropriately differentiating and treating these conditions during pregnancy is important for maternal and fetal well-being.
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2019, Journal of Clinical and Translational EndocrinologyCitation Excerpt :By contrast, heart failure has been reported to occur in about 10% of pregnant women with severe untreated hyperthyroidism, a rate that is much higher than that observed in non pregnant patients [49]. The increased risk of congestive heart failure in thyrotoxic pregnant women would result from an increased cardiac workload imposed by the cumulative effect of thyrotoxic and pregnancy-induced cardiovascular changes and coexistent obstetric complications (severe preeclampsia, haemorrhages, anemia, etc) that precipitate the heart failure [49]. Uncontrolled overt hyperthyroidism also adversely affects fetal health.
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