Postpartum recurrence of Graves’ hyperthyroidism can be prevented by the continuation of antithyroid drugs during pregnancy

Nakagawa, Yasuaki; Mori, Keiichiro; Hoshikawa, Saeko; Yamamoto, Makiko; Ito, Sadayoshi; Yoshida, Katsumi

doi:10.1046/j.1365-2265.2002.01615.x

Cited by 22 publications

(10 citation statements)

References 34 publications

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“…In those women who present only mild hyperthyroidism during the postpartum period, it is reasonable to repeat thyroid function tests 4 to 6 wk after the initial suspicion (hence, before thyroid scanning), because a gradual resolution of hyperthyroidism is more consistent with the transient hyperthyroid phase that characterizes PPTD, thus avoiding additional thyroid scanning (391). Finally, it is important to remember that GD has a tendency to recur during postpartum and that a clinically significant number of women may develop de novo GD after childbirth (392)(393)(394).…”

Section: Management Of Gd In Pregnancymentioning

confidence: 97%

Thyroid Function and Human Reproductive Health

Krassas¹,

2010

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Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.

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Section: Management Of Gd In Pregnancymentioning

confidence: 97%

Thyroid Function and Human Reproductive Health

Krassas¹,

2010

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“…Concerning possible prevention of GD relapse in the postpartum, continuing antithyroid drugs therapy throughout pregnancy prevents recurrence of GD without neonatal hypothyroidism or malformations (41). However, the use of methimazole is related to its potential teratogenic effects, especially in the first trimester of pregnancy (42).…”

Section: Postpartum Thyroid Autoimmunitymentioning

confidence: 99%

Autoimmune Abnormalities of Postpartum Thyroid Diseases

et al. 2017

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The year following parturition is a critical time for the de novo appearance or exacerbation of autoimmune diseases, including autoimmune thyroid disease. The vast majority of postpartum thyroid disease consists of postpartum thyroiditis (PPT) and the minority by Graves’ disease and non-autoimmune thyroiditis. PPT has a worldwide prevalence ranging from 1 to 22% and averaging 5% based on a review published in 2012. Several factors confer risk for the development of PPT. Typically, the clinical course of PPT is characterized by three phases: thyrotoxic, hypothyroid, and euthyroid phase. Approximately half of PPT women will have permanent hypothyroidism. The best humoral marker for predictivity, already during the first trimester of gestation, is considered positivity for thyroperoxidase autoantibodies (TPOAb), though only one-third to half of such TPOAb-positive pregnant women will develop PPT. Nutraceuticals (such as selenium) or omega-3-fatty acid supplements seem to have a role in prevention of PPT. In a recent study on pregnant women with stable dietary habits, we found that the fish consumers had lower rates of positivity (and lower serum levels) of both TPOAb and thyroglobulin Ab compared to meat eaters. Finally, we remind the reader of other diseases that can be observed in the postpartum period, either autoimmune or non-autoimmune, thyroid or non-thyroid.

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“…A study has shown more recurrence of hyperthyroidism in the post partum period in those who had stopped antithyroid therapy compared with those who had continued such treatment throughout pregnancy and post partum (47).…”

Section: What Are the Associated Complications With Antithyroid Drugsmentioning

confidence: 99%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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Introduction: Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo-or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods. Aim: To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation. Methods: A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.' Results: Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. Conclusion: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.

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Postpartum recurrence of Graves’ hyperthyroidism can be prevented by the continuation of antithyroid drugs during pregnancy

Abstract: Continuing antithyroid drug therapy throughout pregnancy prevents postpartum recurrence of Graves' hyperthyroidism without resulting in neonatal hypothyroidism or malformations.

Cited by 22 publications

References 34 publications

Thyroid Function and Human Reproductive Health

Thyroid Function and Human Reproductive Health

Autoimmune Abnormalities of Postpartum Thyroid Diseases

Management of hyperthyroidism during pregnancy and lactation

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