THYROTOXICOSIS IN PREGNANCY

Abstract

Thyrotoxicosis affects approximately 1:500 women of reproductive age. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to physiological adaptation of normal pregnancy. Women with hyperemesis gravidarum (HG) often have biochemical, but not clinical evidence of thyrotoxicosis, which does not need treatment with anti-thyroid drugs (ATDs). For women with clinical thyrotoxicosis, uncertainty regarding the risks of teratogenicity due to ATDs has led to new guideline recommendations for their use in pregnancy. Women with autoimmune diseases such as type I diabetes and who have thyroid peroxidase antibodies (TPOAb) are at an increased risk of developing postpartum thyroiditis, which can result in permanent hypothyroidism. This review summarises the management of thyrotoxicosis in pregnancy and highlights controversial areas for which conclusive evidence is still lacking.