Document Detail


Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy.
MedLine Citation:
PMID:  18849306     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Graves' disease is a common autoimmune disorder in women in fertile ages. The hyperthyroidism is caused by generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves' hyperthyroidism but also in her foetus.The review includes two cases illustrating some of the problems in managing Graves' disease in pregnancy. Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (L-T(4)) given to the mother will have only a limited effect in the foetus. Surgical thyroidectomy of patients with Graves' hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomy+withdrawal of antithyroid medication+L-T(4) replacement of the mother involves a high risk of foetal hyperthyroidism. Conclusion Antithyroid drug therapy of pregnant women with Graves' hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal hyperthyroidism.
Authors:
Peter Laurberg; Claire Bournaud; Jesper Karmisholt; Jacques Orgiazzi
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2008-10-10
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  160     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-17     Completed Date:  2009-01-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  IM    
Affiliation:
Department of Endocrinology and Medicine, Aalborg Hospital, Aalborg, Denmark. peter.laurberg@rn.dk
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MeSH Terms
Descriptor/Qualifier:
Adult
Antithyroid Agents / therapeutic use*
Female
Fetus
Graves Disease / drug therapy,  physiopathology,  surgery,  therapy*
Humans
Pregnancy
Pregnancy Complications / drug therapy,  physiopathology,  surgery,  therapy*
Thyroid Function Tests
Thyroidectomy / adverse effects,  contraindications
Chemical
Reg. No./Substance:
0/Antithyroid Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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