Journal of Endocrinological Investigation

, Volume 34, Issue 3, pp 225–231 | Cite as

Hyperthyroidism and pregnancy. An Italian Thyroid Association (AIT) and Italian Association of Clinical Endocrinologists (AME) joint statement for clinical practice

  • R. NegroEmail author
  • P. Beck-Peccoz
  • L. Chiovato
  • P. Garofalo
  • R. Guglielmi
  • E. Papini
  • M. Tonacchera
  • F. Vermiglio
  • P. Vitti
  • M. Zini
  • A. Pinchera


Hyperthyroidism pregnancy thyroid 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Becks GP, Burrow GN. Thyroid disease and pregnancy. Med Clin N Am 1991, 75: 121–50.PubMedGoogle Scholar
  2. 2.
    Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997, 26: 189–218.PubMedCrossRefGoogle Scholar
  3. 3.
    LeBeau SO, Mandel SJ. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am 2006, 35: 117–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Mestman JH. Hyperthyroidism in pregnancy. Best Pract Res Clin Endocrinol Metab 2004, 18: 267–88.PubMedCrossRefGoogle Scholar
  5. 5.
    Coughlin L, Haddad NG. Struma ovarii presenting as hyperemesis gravidarum in pregnancy. J Obstet Gynecol 2000, 20: 310.CrossRefGoogle Scholar
  6. 6.
    Ballabio M, Poshychinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab 1991,73: 824–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Glinoer D, De Nayer P, Robyn C, Lejeune B, Kinthaert J, Meuris S. Serum levels of intact human chorionic gonadotropin (hCG) and its free alpha and beta subunits, in realtion to maternal thyroid stimulation during normal pregnancy. J Endocrinol Invest 1993, 16: 881–8.PubMedGoogle Scholar
  8. 8.
    Lazarus JH, Kaklamanou M. Significance of low thyroid-stimulating hormone in pregnancy. Curr Opin Endocrinol Diabetes Obes 2007, 14: 389–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Glinoer D. Thyroid hyperfunction during pregnancy. Thyroid 1998, 8: 859–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005, 11: 527–39.PubMedCrossRefGoogle Scholar
  11. 11.
    Patil-Sisodia K, Mestman JH. Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract 2010, 16: 118–29.PubMedCrossRefGoogle Scholar
  12. 12.
    Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989, 160: 63–70.PubMedCrossRefGoogle Scholar
  13. 13.
    Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997, 18: 404–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Abalovich M, Amino M, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007, 92: S1–47.PubMedCrossRefGoogle Scholar
  15. 15.
    Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001, 38: 329–32.PubMedCrossRefGoogle Scholar
  16. 16.
    WHO Secretariat, Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr 2007, 10: 1606–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Velasco I, Carreira M, Santiago P, et al. Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. J Clin Endocrinol Metab 2009, 94: 3234–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Herbst AL, Selenkow HA. Hyperthyroidism during pregnancy. N Engl J Med 1965, 273: 627–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Momotani N, Hisaoka T, Noh J, Ishikawa N, Ito K. Effects of iodine on thyroid status of fetus versus mother in treatment of Graves’ disease complicated by pregnancy. J Clin Endocrinol Metab 1992, 75: 738–44.PubMedGoogle Scholar
  20. 20.
    Zimmermann MB. Iodine Deficiency. End Rev 2009, 30: 376–408.CrossRefGoogle Scholar
  21. 21.
    Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid 1995, 5: 425–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Ostet Gynecol 1994, 84: 946–9.Google Scholar
  23. 23.
    Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989, 160: 63–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Ecker JL, Musci TJ. Thyroid function and disease in pregnancy. Curr Probl Obstet Gynecol Fertil 2000, 23: 109–122.Google Scholar
  25. 25.
    Weetman AP. Graves’ disease. N Engl J Med 2000, 343: 1236–48.PubMedCrossRefGoogle Scholar
  26. 26.
    Anselmo J, Cao D, Karrison T, Weiss RE, Refetoff S. Fetal loss associated with excess thyroid hormone exposure. JAMA 2004, 292: 691–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol 2009, 160: 1–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Polak M, Leger J, Luton D, et al. Fetal cord blood sampling in the diagnosis and the treatment of fetal hyperthyroidism in the offsprings of a euthyroid mother, producing thyroid stimulating immunoglobulins. Ann Endocrinol (Paris) 1997, 58: 338–42.Google Scholar
  29. 29.
    Verberg MF, Gillot DJ, Al-Fradan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005, 11: 527–39.PubMedCrossRefGoogle Scholar
  30. 30.
    Hershman JM. Human chorionic gonadotropin and the thyroid, hyperemesis gravidarum and trophoblastic tumors. Thyroid 1999, 9: 653–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Rodien P, Jordan N, Lefèvre A, et al. Abnormal stimulation of the thyrotropin receptor during gestation. Hum Reprod Update 2004, 10: 95–105.PubMedCrossRefGoogle Scholar
  32. 32.
    Mandel SJ, Brent GA, Larsen PR. Review of antithyroid drug use during pregnancy and report of a case of aplasia cutis. Thyroid 1994, 4: 129.PubMedCrossRefGoogle Scholar
  33. 33.
    Marchant B, Brownlie BE, Hart DM, Horton PW, Alexander WD. The placental transfer of propylthiouracil, methimazole and carbimazole. J Clin Endocrinol Metab 1977, 45: 1187–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Skellern CG, Knight BI, Otter M. The pharmacokinetics of methimazole in pregnant patients after oral administration of carbimazole. Brit J Clin Pharmacol 1980, 9: 145–7.CrossRefGoogle Scholar
  35. 35.
    Gardner DF, Cruikshank DP, Hays PM, Cooper DS. Pharmacology of propylthiouracil (PTU) in pregnant hyperthyroid women: Correlation of maternal PTU concentration with cord serum thyroid function tests. J Clin Endocrinol Metab 1986, 62: 217–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Cheron RG, Kaplan MM, Larsen PR, Selenkow HA, Crigler JF Jr. Neonatal thyroid function after propylthiouracil therapy for maternal Graves’ disease. N Engl J Med 1981, 304: 52–8.CrossRefGoogle Scholar
  37. 37.
    Mortimer R, Cannell GR, Addison R, Johnson LP, Roberts MS, Bernus I. Methimazole and propylthiouracil equally cross the perfused human term placental lobule. J Clin Endocrinol Metab 1997, 82: 3099–102.PubMedGoogle Scholar
  38. 38.
    Cooper DS, Rivkees SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab 2009, 94: 1881–2.PubMedCrossRefGoogle Scholar
  39. 39.
    Clementi M, Di Gianantonio E, Cassina M, Leoncini E, Botto LD, Mastroiacovo P; SAFE-Med Study Group. Treatment of Hyperthyroidism in Pregnancy and Birth Defects. J Clin Endocrinol Metab 2010, 95: E337–41.PubMedCrossRefGoogle Scholar
  40. 40.
    Mestman JH, Manning PR, Hodgman J. Hyperthyroidism and pregnancy. Arch Intern Med 1974, 134: 434–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Redmond GP. Propranolol and fetal growth retardation. Semin Perinatol 1982, 6: 142–4.PubMedGoogle Scholar
  42. 42.
    Sherif IH, Oyan WT, Bosairi S, Carrascal SM. Treatment of hyperthyroidism in pregnancy. Acta Obstet Gynecol Scand 1991, 70: 461–3.PubMedCrossRefGoogle Scholar
  43. 43.
    Amino N, Izumi Y, Hidaka Y, et al. No increase of blocking type anti-thyrotropin receptor antibodies during pregnancy in patients with Graves’ disease. J Clin Endocrinol Metab 2003, 88: 5871–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Amino N, Tanizawa O, Mori H, et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves’ disease. J Clin Endocrinol Metab 1982, 55: 108–12.PubMedCrossRefGoogle Scholar
  45. 45.
    Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Torring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol 2008, 158: 69–75.PubMedCrossRefGoogle Scholar
  46. 46.
    McNab T, Ginsberg J. Use of anti-thyroid drugs in euthyroid pregnant women with previous Graves’ disease. Clin Invest Med. 2005, 28: 127–31.PubMedGoogle Scholar
  47. 47.
    Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010, 31: 702–55.PubMedCrossRefGoogle Scholar
  48. 48.
    Mestman JH, Goodwin TM, Montoro MM. Thyroid disorders of pregnancy. Endocrinol Metab Clin North Am 1995, 24: 41–71.PubMedGoogle Scholar
  49. 49.
    Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg 2009, 144: 399–406.PubMedCrossRefGoogle Scholar
  50. 50.
    Zimmerman D. Fetal and neonatal hyperthyroidism. Thyroid 1999, 9: 727–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Fisher DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol 1997, 40: 16–31.PubMedCrossRefGoogle Scholar
  52. 52.
    Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R. Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn 2003, 23: 740–2.PubMedCrossRefGoogle Scholar
  53. 53.
    Luton D, Le Gac I, Vuillard E, et al. Management of Graves’ disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 2005, 90: 6093–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Ribault V, Castanet M, Bertrand AM, et al; French Fetal Goiter Study Group. Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases. J Clin Endocrinol Metab 2009, 94: 3731–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Nachum Z, Rakover Y, Weiner E, Shalev E. Graves’ disease in pregnancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol 2003, 189: 159–65.PubMedCrossRefGoogle Scholar
  56. 56.
    Buscaglia M, Ghisoni L, Bellotti M, et al. Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years’ experience. Fetal Diagn Ther 1996, 11: 106–13.PubMedCrossRefGoogle Scholar
  57. 57.
    Kong CW, Leung TN, Leung TY, et al. Risk factors for procedurerelated fetal losses after mid-trimester genetic amniocentesis. Prenat Diagn 2006, 26: 925–30.PubMedCrossRefGoogle Scholar
  58. 58.
    Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab 2001, 86: 2354–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Kampmann JP, Johansen K, Hansen JM, Helweg J. Propylthiouracil in human milk. Revision of a dogma. Lancet 1980, 1: 736–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Momotani N, Noh JY, Ishikawa N, Ito K. Effects of propylthiouracil and methimazole on fetal thyroid status in mothers with Graves’ hyperthyroidism. J Clin Endocrinol Metab 1997, 82: 3633–6.PubMedGoogle Scholar
  61. 61.
    Azizi F, Hedayati M. Thyroid function in breast-fed infants whose mothers take high doses of methimazole. J Endocrinol Invest 2002, 25: 493–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Azizi F, Khoshniat M, Bahrainian M, Hedayati M. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. J Clin Endocrinol Metab 2000, 85: 3233–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Törnhage CJ, Grankvist K. Acquired neonatal thyroid disease due to TSH receptor antibodies in breast milk. J Pediatr Endocrinol Metab 2006, 19: 787–94.PubMedGoogle Scholar
  64. 64.
    Matsuura N, Harada S, Ohyama Y, et al. The mechanisms of transient hypothyroxinemia in infants born to mothers with Graves’ disease. Pediatr Res 1997, 42: 214–8.PubMedCrossRefGoogle Scholar
  65. 65.
    McKenzie JM, Zakarija M. Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor antibodies. Thyroid 1992, 2: 155–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Papendieck P, Chiesa A, Prieto L, Gruñeiro-Papendieck L. Thyroid disorders of neonates born to mothers with Graves’ disease. J Pediatr Endocrinol Metab 2009, 22: 547–53.PubMedCrossRefGoogle Scholar
  67. 67.
    Kamijo K. TSH-receptor antibodies determined by the first, second and third generation assays and thyroid-stimulating antibody in pregnant patients with Graves’ disease. Endocr J 2007, 54: 619–24.PubMedCrossRefGoogle Scholar
  68. 68.
    Polak M, Le Gac I, Vuillard E, et al. Fetal and neonatal thyroid function in relation to maternal Graves’ disease. Best Pract Res Clin Endocrinol Metab 2004, 18: 289–302.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2011

Authors and Affiliations

  • R. Negro
    • 1
    Email author
  • P. Beck-Peccoz
    • 2
  • L. Chiovato
    • 3
  • P. Garofalo
    • 4
  • R. Guglielmi
    • 5
  • E. Papini
    • 5
  • M. Tonacchera
    • 6
  • F. Vermiglio
    • 7
  • P. Vitti
    • 6
  • M. Zini
    • 8
  • A. Pinchera
    • 6
  1. 1.Division of Endocrinology“V. Fazzi” HospitalLecceItaly
  2. 2.Endocrine Unit, Fondazione IRCCS Ca’ GrandaUniversity of MilanMilan
  3. 3.Fondazione Salvatore Maugeri IRCCSUniversity of PaviaPavia
  4. 4.Division of EndocrinologyA.O. “V. Cervello”Palermo
  5. 5.Department of Endocrine and Metabolic DiseasesRegina Apostolorum HospitalAlbano Laziale (Roma)
  6. 6.Department of EndocrinologyUniversity of PisaPisa
  7. 7.Dipartimento Clinico-Sperimentale di Medicina e Farmacologia, Sezione di EndocrinologiaUniversity of MessinaMessina
  8. 8.Endocrinology Division and Thyroid Disease CenterArcispedale Santa Maria NuovaReggio EmiliaItaly

Personalised recommendations