HYPERTHYROIDISM
DURING PREGNANCY
Hyperthyroidism
(HT) during pregnancy is usually treated using antithyroid drugs (ATDs).
However, ATDs use during pregnancy is associated with an increased risk for the
development of birth defects, especially when methimazole (MMI) is used during
gestational weeks 6 – 10 and include dysmorphic faces, aplasia cutis, choanal
or esophageal atresia, abdominal wall defects, umbilical hernia, ventricular
septal defects etc. The prevalence of birth defects is the same with propylthiouracil
(PTU), but the spectrum of these defects is less severe (primarily face and
neck cysts and urinary tract abnormalities, especially in males). Propranolol
can be used during pregnancy if required; however, long-term treatment should
be avoided since may cause intrauterine growth retardation, fetal bradycardia
and neonatal hypoglycemia. Thyroidectomy during pregnancy for the management of
hyperthyroidism may be required in selected cases (such as allergy or fear to
use ATDs because of associated risks for birth defects, presence of massive
enlargement and/or large nodules causing pressure symptoms or coexisting
malignancy). If required, surgery can be safely performed during the second
trimester of pregnancy. Obviously, radioiodine therapy (more popular in the US,
rarely used in Europe) is contraindicated during pregnancy because of the
deleterious effects of irradiation on the fetus.
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