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Advances in the differential diagnosis of transient hyperthyroidism in pregnancy and Graves’ disease

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Abstract

Background

The occurrence of thyrotoxicosis during pregnancy is mainly attributed to gestational transient thyrotoxicosis (GTT) and Graves’ disease (GD). It is important to distinguish between GTT and Graves’ disease because the two diseases are treated very differently. However, a gold standard for the differential diagnosis of the two diseases is currently lacking, and the most common method of differentiation is based on past medical history and clinical presentation combined with thyroid-related antibodies.

Methods

A literature search of the electronic databases PubMed, Embase, Medline, Google Scholar, Cochrane Library, China Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Full Text Database and China Biomedical CD-ROM was performed. The search period ranged from journal inception until 2022. We used the following search terms in “All fields”: {[“thyroid” (common field) OR “thyroid” (subject line)] OR “hyperthyroidism” (common field)} AND {[“pregnancy” (title) OR “pregnancy” (title)] AND “one over” (common field)} OR {[“pregnancy” (common field) OR “pregnancy” (common field) OR “pregnancy” (subject line)] AND “Graves’” (common field)}.

Results

In recent years, some clinical studies at home and abroad have proposed other meaningful differential indicators, such as thyroid stimulating hormone, chorionic gonadotropin, thyroid hormone levels and thyroid ultrasound.

Conclusion

The differential diagnostic significance of each of these indicators is summarised here with the goal of providing a better reference for the differential diagnosis of hyperthyroidism during pregnancy in clinical practice.

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Abbreviations

GTT:

Gestational transient thyrotoxicosis

GD:

Graves’ disease

TSH:

Thyroid stimulating hormone

HCG:

Chorionic gonadotropin

STA-PSV:

Systolic peak velocity of the superior thyroid artery

STA-D:

Diastolic internal diameter of the superior thyroid artery

AITD:

Autoimmune thyroid disease

TSI:

Thyroglobulin

cAMP:

Cyclic adenosine monophosphate

TBG:

Thyroxine-binding globulin

TMD:

Transmembrane structural domain

IMH:

Isolated maternal hypothyroidism

FTHI:

FT3 index/FT4 index

ATA:

American Thyroid Association

ES:

The Endocrine Society

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Funding

The Natural Science Foundation of Shenzhen City, China to ZL (No.KCXFZ20201221173600001)

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, The Second Clinical Medical College, Jinan University (Shenzhen People′s Hospital), Shenzhen, Guangdong, China

    Nian Guo & Zhen Liang

  2. Department of Endocrinology and Metabolism, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

    Meng Xue

  3. Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

    Zhen Liang

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The first draft of the manuscript was written by NG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zhen Liang.

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Guo, N., Xue, M. & Liang, Z. Advances in the differential diagnosis of transient hyperthyroidism in pregnancy and Graves’ disease. Arch Gynecol Obstet 308, 403–411 (2023). https://doi.org/10.1007/s00404-022-06774-z

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