Endocrine Abstracts

Objectives: Evaluation of functional thyroid alterations in correlation with hyperemesis gravidarum (HG).

Material and method: Study performed on a group of 136 pregnant women with HG and a control group of 101 pregnant women. In both groups, cases with a known history of thyroid disease, molar pregnancy, multiple pregnancies or other systemic chronic diseases were excluded. Patients were clinically and serologically examined (TSH, FT4, ATPO, TRAb), the residence being the perimarine area of Romania.

Results/discussion: Thyroid dysfunction prevailed in pregnant women with HG (53.6% versus 38%). Functionally pregnant women with hyperemesis presented: 44.8% subclinical thyrotoxicosis; 46% - normothyroidism; 3% - subclinical hypothyroidism; 5.8% – thyrotoxicosis; 9.5% – pathologic ATPO level; 0.4% had elevated TRAb. In the control group, pathological changes were: 62% – normothyroidism, 27% - subclinical hypothyroidism, 11% – subclinical thyrotoxicosis. Pregnant subjects with HG showed lower mean TSH than control (1.22±0.64 μU/ml vs 2.18±1.10 μUI/ml); also elevated FT4 values in the study group compared to the control group (17±1.37 pmol/l vs. 15.4±0.82 pmol/l), but all values were within normal range for the first trimester range. The incidence of autoimmune thyroid disease was significantly higher in women who also had hiperemesis gravidarum compared to the control group (9.5% versus 3.9%). The mean ATPO was slightly increased in the HG group (138±9.61 IU/ml) vs. control group (127±11 IU/ml). There have been two cases of spontaneous abortion associated with thyrotoxicosis (1.4%) without antithyroid therapy. In the remaining cases with thyrotoxicosis, without clinical manifestations, were not established specific treatment, and between 11 and 14 weeks serum hormonal values in this group were normalized. Pregnant women with hypothyroidism have received levo-thyroxine treatment in doses between 25 and 75 μg/day with normalization of hormone serum levels.

Conclusions: Pregnant women with hyperemesis gravidarum associated thyroid autoantibodies and functional thyroid abnormalities require obstetrical follow-up and pre/postpartum thyroid reevaluation. For expectant mothers with subclinical thyrotoxicosis, the transient character of thyroid functional disorder is often considered. Pregnancy can be a way of onset of autoimmune thyroid dysfunction.