Endocrine Abstracts

Objectives: Hyperthyroidism in pregnancy presents a challenge for medical doctor, patient and products of conception.

Aim of the study: To specify the peculiarities of expression of hyperthyroidism in pregnant women, diagnosis, monitoring, treatment, prognosis of pregnancy and effect on the fetus.

Materials and methods: The study included a total of 27 women with hyperthyroidism of which 15 (group A) had thyrotoxicosis before conception and 12 (group B) were diagnosed during pregnancy. All pregnant women with thyrotoxicosis received treatment with propylthiouracil in average dose: 200 mg/day (n=5, 26.31%), those in maintained remission during pregnancy received 50 mg/day (n=14, 73.68%).

Results: Dosage anti TSH-receptor antibodies (TRAb) revealed pathological values in a number of 9 patients (60%) including 4 pregnant with ophthalmopathy. Of the 27 pregnancies studied initially remained in development a number of 19 (70.37%), three cases with known hyperthyroidism did not want pregnancy preferred therapeutic abortion, all presenting also ophthalmopathy; three cases had suffered spontaneous abortion in weeks 13, 17 and 19 respectively; for two cases it was decided to practice therapeutic abortion in week 16 and 21 due to heart rhythm abnormalities correlated with persistent thyrotoxicosis with increased necessary for propylthiouracil and beta-blocker. In pregnant women who completed pregnancy were found two birth before term. For patients with ophthalmopathy remaining pregnant (n=4) were not found symptoms and signs of progressive disease, correlated with serum levels of thyroid hormones and TRAb in remission. Mentioned one case with esophageal atresia in a female infant whose mother received propylthiouracil monotherapy 200 mg/day initiated within 16 weeks of pregnancy.

Conclusions: Hyperthyroidism in pregnant woman poses problems of diagnosis and monitoring due to maternal–fetal risk. Abortion rate is generally high both in terms of the decision, therapeutic and pathological. After the first trimester there is often an ‘improvement’ of clinical symptoms and autoimmune process: ophthalmopathy evolution; incidence of pathological TRAb serum levels.