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Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review

King, Jennifer Renae MD; Lachica, Ruben MD; Lee, Richard H. MD; Montoro, Martin MD; Mestman, Jorge MD

Obstetrical & Gynecological Survey: November 2016 - Volume 71 - Issue 11 - p 675–685
doi: 10.1097/OGX.0000000000000367
CME ARTICLES
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CME

Importance Hyperthyroidism has important implications for pregnancy, affecting both mother and fetus. Appropriate maternal and fetal management iscritical to avoiding adverse pregnancy outcomes and requires a multidisciplinary approach.

Objective To describe maternal diagnosis and management of hyperthyroidism, across all stages of pregnancy. In addition, to review clinical signs of fetal thyroid dysfunction due to maternal Graves disease and discuss management considerations.

Evidence Acquisition Review of published articles on PubMed and guidelines by recognized governing organizations regarding the diagnostic and management considerations for hyperthyroidism in pregnancy, from preconception to the postpartum period.

Results Diagnosis of maternal hyperthyroidism involves both clinical symptoms and laboratory findings. Antithyroid medications are the mainstay of therapy, with trimester-specific pregnancy goals. Hyperthyroidism due to Graves disease has important diagnostic and management considerations for the fetus and neonate.

Conclusions and Relevance Hyperthyroidism in pregnancy affects mother, fetus, and neonate. Interpretation of thyroid tests and understanding the appropriate use of antithyroid drugs are fundamental. Proper education of physicians providing care to women with hyperthyroidism is essential and starts before pregnancy. Postpartum follow-up is an essential part of the care. A systematic approach to management will ensure optimal pregnancy outcomes.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this activity, the learner should be better able to: (1) describe the diagnosis of hyperthyroidism in pregnancy, (2) discuss medical management of hyperthyroidism during pregnancy, (3) review the clinical signs of fetal thyroid dysfunction, (4) describe the symptoms and treatment of thyroid storm in pregnancy, and (5) review management considerations in the postpartum period for women with hyperthyroidism.

*Fellow, †Resident, and ‡Associate Professor of Clinical Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology; and §Professor of Clinical Medicine and Obstetrics and Gynecology, Departments of Internal Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA

Dr. King has disclosed that the U.S. Food and Drug Administration has not approved the use of Levothyroxine/PTU/Methimazole for the treatment of fetal hypo/hyperthyroidism as discussed in this article. Please consult the product’s labeling for approved information.

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Jennifer Renae King, MD, Department of Obstetrics and Gynecology, University of Southern California, LAC + USC Medical Center, 1200 N. State St., Inpatient Tower, Room C3F107, Los Angeles, CA 90033. E-mail: jennifrk@usc.edu.

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