Skip to main content
Log in

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

  • Opinion
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Becks GP, Burrow GN. Thyroid disease and pregnancy. Med Clin N Am 1991, 75: 121–50.

    CAS  PubMed  Google Scholar 

  2. Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997, 26: 189–218.

    Article  CAS  PubMed  Google Scholar 

  3. LeBeau SO, Mandel SJ. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am 2006, 35: 117–36.

    Article  PubMed  Google Scholar 

  4. Mestman JH. Hyperthyroidism in pregnancy. Best Pract Res Clin Endocrinol Metab 2004, 18: 267–88.

    Article  CAS  PubMed  Google Scholar 

  5. Coughlin L, Haddad NG. Struma ovarii presenting as hyperemesis gravidarum in pregnancy. J Obstet Gynecol 2000, 20: 310.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  8. Lazarus JH, Kaklamanou M. Significance of low thyroid-stimulating hormone in pregnancy. Curr Opin Endocrinol Diabetes Obes 2007, 14: 389–92.

    Article  CAS  PubMed  Google Scholar 

  9. Glinoer D. Thyroid hyperfunction during pregnancy. Thyroid 1998, 8: 859–64.

    Article  CAS  PubMed  Google Scholar 

  10. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005, 11: 527–39.

    Article  CAS  PubMed  Google Scholar 

  11. Patil-Sisodia K, Mestman JH. Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract 2010, 16: 118–29.

    Article  PubMed  Google Scholar 

  12. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989, 160: 63–70.

    Article  CAS  PubMed  Google Scholar 

  13. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997, 18: 404–33.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  15. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001, 38: 329–32.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  18. Herbst AL, Selenkow HA. Hyperthyroidism during pregnancy. N Engl J Med 1965, 273: 627–33.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  20. Zimmermann MB. Iodine Deficiency. End Rev 2009, 30: 376–408.

    Article  CAS  Google Scholar 

  21. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid 1995, 5: 425–34.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  23. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989, 160: 63–70.

    Article  CAS  PubMed  Google Scholar 

  24. Ecker JL, Musci TJ. Thyroid function and disease in pregnancy. Curr Probl Obstet Gynecol Fertil 2000, 23: 109–122.

    Google Scholar 

  25. Weetman AP. Graves’ disease. N Engl J Med 2000, 343: 1236–48.

    Article  CAS  PubMed  Google Scholar 

  26. Anselmo J, Cao D, Karrison T, Weiss RE, Refetoff S. Fetal loss associated with excess thyroid hormone exposure. JAMA 2004, 292: 691–5.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  29. Verberg MF, Gillot DJ, Al-Fradan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005, 11: 527–39.

    Article  CAS  PubMed  Google Scholar 

  30. Hershman JM. Human chorionic gonadotropin and the thyroid, hyperemesis gravidarum and trophoblastic tumors. Thyroid 1999, 9: 653–7.

    Article  CAS  PubMed  Google Scholar 

  31. Rodien P, Jordan N, Lefèvre A, et al. Abnormal stimulation of the thyrotropin receptor during gestation. Hum Reprod Update 2004, 10: 95–105.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  38. Cooper DS, Rivkees SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab 2009, 94: 1881–2.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  40. Mestman JH, Manning PR, Hodgman J. Hyperthyroidism and pregnancy. Arch Intern Med 1974, 134: 434–9.

    Article  CAS  PubMed  Google Scholar 

  41. Redmond GP. Propranolol and fetal growth retardation. Semin Perinatol 1982, 6: 142–4.

    CAS  PubMed  Google Scholar 

  42. Sherif IH, Oyan WT, Bosairi S, Carrascal SM. Treatment of hyperthyroidism in pregnancy. Acta Obstet Gynecol Scand 1991, 70: 461–3.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  47. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010, 31: 702–55.

    Article  CAS  PubMed  Google Scholar 

  48. Mestman JH, Goodwin TM, Montoro MM. Thyroid disorders of pregnancy. Endocrinol Metab Clin North Am 1995, 24: 41–71.

    CAS  PubMed  Google Scholar 

  49. Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg 2009, 144: 399–406.

    Article  PubMed  Google Scholar 

  50. Zimmerman D. Fetal and neonatal hyperthyroidism. Thyroid 1999, 9: 727–33.

    Article  CAS  PubMed  Google Scholar 

  51. Fisher DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol 1997, 40: 16–31.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  58. Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab 2001, 86: 2354–9.

    Article  CAS  PubMed  Google Scholar 

  59. Kampmann JP, Johansen K, Hansen JM, Helweg J. Propylthiouracil in human milk. Revision of a dogma. Lancet 1980, 1: 736–7.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  65. McKenzie JM, Zakarija M. Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor antibodies. Thyroid 1992, 2: 155–9.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Negro MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Negro, R., Beck-Peccoz, P., Chiovato, L. et al. Hyperthyroidism and pregnancy. An Italian Thyroid Association (AIT) and Italian Association of Clinical Endocrinologists (AME) joint statement for clinical practice. J Endocrinol Invest 34, 225–231 (2011). https://doi.org/10.1007/BF03347071

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03347071

Key-words

Navigation