Hyperthyroidism during pregnancy: Treatment
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
- Section Editors
- David S Cooper, MD
David S Cooper, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Thyroid Disease
- Professor of Medicine and International Health
- Johns Hopkins University School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
The evaluation and treatment of pregnant women with hyperthyroidism parallels that of nonpregnant women and men, but presents some unique problems. There are several important issues that must be considered when hyperthyroidism occurs during pregnancy. These include understanding the indications for treatment, the therapeutic options for pregnant women, and the goals of antithyroid drug (ATD) therapy.
The treatment of hyperthyroidism during pregnancy is presented here. The clinical manifestations, diagnosis, and causes of hyperthyroidism and other aspects of thyroid disease during pregnancy are discussed separately. (See "Hyperthyroidism during pregnancy: Clinical manifestations, diagnosis, and causes" and "Overview of thyroid disease in pregnancy".)
The Endocrine Society and the American Thyroid Association (ATA) have published clinical guidelines for the management of thyroid dysfunction during pregnancy that are similar to the approach outlined here [1-3]. Treatment recommendations are predominantly based upon observational studies and clinical experience.
Indications — Graves' disease and human chorionic gonadotropin (hCG)-mediated hyperthyroidism are the most common causes of hyperthyroidism during pregnancy; toxic adenomas and toxic multinodular goiter are seen less commonly. (See "Hyperthyroidism during pregnancy: Clinical manifestations, diagnosis, and causes", section on 'Establishing the cause'.)
hCG-mediated hyperthyroidism (gestational transient thyrotoxicosis) is usually transient and does not require treatment. Similarly, the thyroid hyperfunction in women with hyperemesis gravidarum usually does not require treatment because it is mild and subsides as hCG production falls (typically by 14 to 18 weeks gestation). Women with severe hyperemesis, however, require treatment of dehydration with intravenous fluids. (See "Treatment and outcome of nausea and vomiting of pregnancy".)
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- Therapeutic options
- Beta blockers
- - Possible teratogenicity
- - Choice of drug
- - Dose and monitoring
- - Nursing
- T4 administration
- FETAL HYPERTHYROIDISM
- Measurement of maternal antibodies
- - Fetal blood sampling
- Neonatal hyperthyroidism
- POSTPARTUM ISSUES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Fetal monitoring