Perinatal outcomes in post-thyroidectomy pregnancies

Cohen, Neta; Levy, Amalia; Wiznitzer, Arnon

doi:10.3109/09513590.2010.491166

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…Wasserstrum & Anania (1995) reviewed 43 pregnancies of women with hypothyroidism and reported an increased rate of cesarean section due to fetal distress in women with ‘severe hypothyroidism’ (Wasserstrum & Anania, 1995). A previous study based on our population database, found a cesarean sections rate of 30% in pregnancies complicated by hypothyroidism (Cohen et al, 2011). Collectively these reports are in accord with our findings, of an incidence of 23% and 27% cesarean section in the hypothyroidism and DM groups, respectively.…”

Section: Discussionmentioning

confidence: 80%

Hypothyroidism and diabetes mellitus – a risky dual gestational endocrinopathy

Tirosh

Benshalom-Tirosh

Novack

et al. 2013

PeerJ

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Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome.Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296).Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84).Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.

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Section: Discussionmentioning

confidence: 80%

Hypothyroidism and diabetes mellitus – a risky dual gestational endocrinopathy

Tirosh

Benshalom-Tirosh

Novack

et al. 2013

PeerJ

Self Cite

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“…9 These data are consistent with previous literature showing higher rates of maternal and fetal/infant outcomes in pregnancies complicated by maternal hypothyroidism. [5][6][7] Specifically, thyroid autoimmunity in combination with high TSH concentrations early in gestation has been associated with a fourfold increased risk of gestational diabetes for the mother.…”

Section: Discussionmentioning

confidence: 99%

“…4 Thyroid dysfunction in pregnancy has been associated with a range of adverse maternal and fetal/infant outcomes. [5][6][7] Questions have been raised regarding increased risks of cognitive dysfunction and other adverse neurodevelopmental outcomes in children born to mothers with various degrees of maternal hypothyroidism. 8,9 Although much research was devoted to neurocognitive outcome of offspring, data are lacking on other health outcomes, both in the short-and long-term perspective.…”

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confidence: 99%

Maternal Hypothyroidism during Pregnancy and the Risk of Pediatric Endocrine Morbidity in the Offspring

et al. 2018

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Objective Previous studies suggested maternal hypothyroidism during pregnancy to be associated with cognitive impairment of the offspring. Scarce data exist regarding long-term endocrine health of the offspring. This study was aimed to assess whether children born to mothers with hypothyroidism during pregnancy are at an increased risk for long-term endocrine morbidity. Study Design A retrospective population-based cohort study compared long-term endocrine morbidity of children born between the years 1991 and 2014 to mothers with and without hypothyroidism. Multiple gestations, fetuses with congenital malformations, and women lacking prenatal care were excluded. Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated according to a predefined set of ICD-9 codes. Kaplan–Meier's survival curves were used to compare the cumulative risk and a Cox multivariable model was used to adjust for confounders. Results During the study period, 217,910 deliveries met the inclusion criteria; 1.1% of which were with maternal hypothyroidism (n = 2,403). During the follow-up period, the cumulative incidence of endocrine morbidity among children born to mothers with hypothyroidism was 27 per 1,000 person-years and 0.47 per 1,000 person-years in the comparison group (relative risk: 2.14; 95% confidence interval [CI]: 1.21–3.79). The Kaplan–Meier's survival curve demonstrated a significantly higher cumulative endocrine morbidity in children born to mothers with hypothyroidism (log-rank test, p = 0.007). In the Cox regression model controlled for maternal age, birth weight, preterm birth, maternal diabetes, hypertensive disorders of pregnancy, induction of labor, and mode of delivery, maternal hypothyroidism was found to be independently associated with pediatric endocrine morbidity in the offspring (adjusted hazard ratio = 1.92, 95% CI: 1.08–3.4, p = 0.025). Conclusion Maternal hypothyroidism appears to be independently associated with long-term pediatric endocrine morbidity of the offspring.

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“…An increased risk for adverse obstetric outcomes was reported in 50 women after total thyroidectomy [25], but the majority were treated for thyroid cancer, and we have not found any report on pregnancy outcome after thyroidectomy in women with Graves’ disease. Altogether, in women with Graves’ disease who have high TRAb titers and plan pregnancy, the risks associated with thyroidectomy should be balanced against the risks for the fetus and neonate.…”

Section: Discussionmentioning

confidence: 62%

Impact of Thyrotropin Receptor Antibody Levels on Fetal Development in Two Successive Pregnancies in a Woman with Graves’ Disease

Bjørgaas¹,

Farstad

Christiansen³

et al. 2012

Horm Res Paediatr

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Background: Treatment with radioiodine for Graves’ disease regularly increases the level of antithyroid antibodies, and transplacental passage of stimulating thyrotropin receptor antibodies (TRAb) may cause fetal hyperthyroidism. Case presentation: A 21-year-old woman with Graves’ disease received radioiodine treatment to avoid use of antithyroid drugs in pregnancy. She became pregnant 4 months later and was euthyroid during pregnancy. In gestational week (GW) 33, she was admitted with an increased fetal heart rate of 176–180 beats/min. Fetal echocardiography indicated cardiac decompensation. The neonate had severe hyperthyroidism (free thyroxine >100 pmol/l, nv 12.0–22.0), cardiac insufficiency, insufficient weight gain, goiter and considerably accelerated skeletal age. In the mother and neonate, TRAb was >40 IU/l (nv <1.0), indicating transplacental passage of stimulating antibodies. After delivery, TRAb remained >40 IU/l in the woman, and 18 months later she underwent total thyroidectomy with subsequent decline in TRAb. In her next pregnancy, TRAb fluctuated between 38 and 17 IU/l, and repeated fetal ultrasound showed no goiter or sign of hyperthyroidism. In cord blood, TRAb was 10.9 IU/l, and the neonate had normal thyroid hormone levels. Conclusion: This case report illustrates the impact of maternal TRAb level for neonatal outcome in two successive pregnancies.

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Perinatal outcomes in post-thyroidectomy pregnancies

Abstract: Women post-total thyroidectomy and women with hypothyroidism due to other reasons are at increased risk for adverse obstetric outcomes, while the risk is higher for pregnancies with total thyroidectomy as compared to hypothyroidism due to other reasons.

Cited by 9 publications

References 7 publications

Hypothyroidism and diabetes mellitus – a risky dual gestational endocrinopathy

Hypothyroidism and diabetes mellitus – a risky dual gestational endocrinopathy

Maternal Hypothyroidism during Pregnancy and the Risk of Pediatric Endocrine Morbidity in the Offspring

Impact of Thyrotropin Receptor Antibody Levels on Fetal Development in Two Successive Pregnancies in a Woman with Graves’ Disease

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