Follow-up and evaluation of the pregnancy outcome in women of reproductive age with Graves’ disease after 131Iodine treatment

Abstract

The aims of the present study were to analyze the outcomes of pregnancy, after 131I treatment, in patients of reproductive age with Graves’ hyperthyroidism and to investigate the effects, if any, of the 131I treatment on the mothers and newborns. From 2009 to 2014, 257 pregnant female patients with Graves’ hyperthyroidism in the outpatients at the Department of Nuclear Medicine and 166 healthy pregnant women from the Department of Obstetrics at Sun Yat-Sen Memorial Hospital were included in our study. They were divided into a 131I therapy group (n = 130) and an anti-thyroid drug (ATD) group (n = 127) according to their therapy before conception. The neonatal gender, rate of preterm birth, body weight ratio and occurrence of low birth weight [except for higher rates of abortion (odds ratio; OR = 2.023) and cesarean delivery (OR = 1.552) in patients with Graves’ hyperthyroidism] showed no statistically significant differences from those of the healthy group (P > 0.05). The level of intrauterine growth restriction did not differ between the Graves’ hyperthyroidism group and the healthy group (8 vs 2, 3.0% vs 1.2%). The outcomes of pregnancy among the 131I therapy group, ATD group and healthy group also showed no significant differences. Of the patients treated with 131I, no significant differences were observed in the outcomes of their pregnancies, whether they received propylthiouracil (PTU), levothyroxine or no additional drug treatment during pregnancy. Women with hyperthyroidism who were treated with 131I therapy could have normal delivery if they ceased 131I treatment for at least six months prior to conception and if their thyroid function was reasonably controlled and maintained using the medication: anti-thyroid drug and levothyroxine before and during pregnancy.

Neonates Born to Mothers with Graves’ Disease: 15 Year Experience of a Pediatric Endocrinology Department

“…The lack of information led to a pregnant woman undergoing 131 I therapy, compromising the control of the disease and culminating in a case of early neonatal hyperthyroidism, when different studies advise a safety window of 6 months between 131 I therapy and pregnancy. 6,7,18 By maintaining focus on the mother's treatment, there was a decrease in the number of women on ATD during the third trimester, which is in line with the decrease of immune activity at the end of gestation. 1 The use of methimazole (MMI) during the first trimester, an arguable point, as previously mentioned, represented almost 30% of mothers and one case presented with ultrasound abnormalities (fetal growth restriction).…”

“…2 The 131 I is precluded as a treatment during gestation, and surgery is indicated only for special cases, preferably during the second trimester. 2,6 For the Pediatrician, there is importance in the fetal and subsequent neonatal outcomes. Fetal hyperthyroidism goes from unnoticed to being the cause of fetal death, but may also comprise goiter, growth restriction, oligohydramnios and prematurity.…”

Comparative Safety of Therapies for Hyperthyroidism Planning Pregnancy: A Network Meta-analysis

“…We identified 6 eligible articles, and 2 articles were excluded because the author couldn't be contacted for complete data [7,8] . Overall, 4 cohort studies published between 2014 and 2018 were included in the meta-analysis: 3 English articles were from PubMed database [9][10][11] and 1 Chinese article was from CNKI database [12] (Figure1). These studies involved a total of 480 patients (234 in the ATD group, 147…”

Riscos E Benefícios Do Tratamento Do Hipertireoidismo Gestacional: Uma Atualização

“…Encontrada majoritariamente em mulheres, a enfermidade tem relação com mecanismos autoimunes. 11 Outras etiologias menos comuns compreendem bócio nodular tóxico e adenoma tóxico, relacionados ao funcionamento autônomo de nódulos tireoidianos, e tireoidite, afecção inflamatória da glândula tireoide. 3 Estudos mostram que o controle inadequado do hipertireoidismo gestacional é associado a complicações maternas como maior risco de preeclâmpsia, aumento da incidência de partos cesarianos devido principalmente a estresse fetal, necessidade maior de indutores de parto, trabalho de parto espontâneo, doença cardíaca congestiva, arritmias cardíacas e diabetes mellitus gestacional.…”

“…5 Uma pesquisa comparando um grupo de gestantes com doença de Graves, em controle adequado da função tireoidiana previamente à concepção, e um grupo controle de gestantes saudáveis demonstrou que o controle adequado da função tireoidiana resultou em taxa de pré-termos semelhante ao grupo controle, indicando que o tratamento representa menor risco de complicações do hipertireoidismo na gravidez. 11 A terapia de primeira linha para doença de Graves gestacional envolve as drogas Proptiouracil (PTU), Carbimazol (CMZ) e Metimazol (MMI). Historicamente, o uso de PTU é preferencial, enquanto MMI é usado como segunda opção, devido ao risco de malformações fetais, descritos como "Embriopatia por Metimazol".…”