Hyperthyroidism in pregnancy

Hyperthyroidism-what is the disease?

Hyperthyroidism, otherwise known as hyperthyroidism, is a disease associated with an excess of hormones produced by the thyroid gland. At the same time, in its most common types, there is a compensatory decrease in TSH, the hormone that is responsible for stimulating the thyroid gland to work under normal conditions.

Hyperthyroidism in pregnancy- causes

One of the most common causes of hyperthyroidism in pregnancy is so-called gestational thyrotoxicosis. During pregnancy, especially at the beginning, the concentration of chorionic gonadotropin (beta- hcg), which resembles TSH in terms of its structure, increases. In high concentrations, it can cause, usually subclinical, hyperthyroidism. In this situation, in most patients it is sufficient to monitor thyroid function slightly more often than in women with normal TSH levels, or alternatively, symptomatic treatment is used in the case of severe complaints. However, gestational thyrotoxicosis can cause vomiting in pregnant women, so if unrestrained vomiting is present, evaluation of free thyroid hormones and TSH levels is indicated. Women have a higher risk of subclinical hyperthyroidism in multiple pregnancies, where beta- hcg levels are proportionally higher than in singleton pregnancies.

The second most common cause is Graves-Basedow disease, in the course of which there is a stimulation of the thyroid gland to produce hormones by its own, abnormal, antibodies. It is a condition that requires close care from an endocrinology specialist both during and after pregnancy. Most patients also have pharmacotherapy implemented.

Hyperthyroidism in pregnancy- symptoms

The symptoms of hyperthyroidism in pregnancy are nonspecific. This is related to the fact that during pregnancy, and especially in the first weeks of pregnancy, many symptoms are considered to be those accompanying the first trimester of pregnancy. Symptoms of hyperthyroidism include:

• accelerated heart rate,
• sweating,
• trembling hands
• agitation,
• insomnia,
• weight loss,
• severe vomiting

Hyperthyroidism in pregnancy- treatment

The first step in the management of hyperthyroidism is to distinguish gestational thyrotoxicosis from Graves-Basedow disease. This is made possible by testing antibodies to the TSH receptor, known as the “TSH receptor. TRAb- in Graves-Basedow disease, TRAb levels will be elevated, while in thyrotoxicosis of pregnancy they will be normal.

Subclinical hyperthyroidism generally does not require treatment. And if gestational thyrotoxicosis produces symptoms, it is most often treated with propranolol. The more frequent monitoring of thyroid hormones mentioned earlier is also necessary.

For Graves-Basedow disease, the drugs used are thiamazole and propylthiouracil. These drugs are used in the lowest effective doses under the supervision of a gynecologist and an endocrinologist.

Hyperthyroidism in pregnancy- complications

Overt hyperthyroidism in pregnancy can carry consequences. Among them, the most common are premature separation of the placenta, hypertension, pre-eclampsia, miscarriage and preterm labor. The disease can also affect the fetus. This is because the appearance of fetal hyperactivity, goiter, tachycardia or growth restriction can occur, resulting in hypotrophy. Because of the risk of preterm labor, the baby may also be at risk of complications associated with prematurity. For this reason, it is extremely important to monitor thyroid function during pregnancy and follow the recommendations of specialists.