Thyrotoxicosis complicating pregnancy

Lowell Davis, Michael J. Lucas, Gary D V Hankins, Micki L. Roark, F. Gary Cunningham

Research output: Contribution to journalArticle

219 Scopus citations

Abstract

During the 12-year period from 1974 through 1985, nearly 120,000 women were delivered of infants at Parkland Hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them (1:2000). Initial treatment was based on clinical assessment, and propylthiouracil was usually given in doses of 300 to 800 mg daily. In compliant women seen by midpregnancy, euthyroidism was achieved by a mean of 8 weeks; however, the daily dose was decreased to ≤150 mg by delivery in only 10%. Metabolic status at delivery correlated directly with pregnancy outcome, and women treated earlier in pregnancy were more likely to be euthyroid at delivery and to have good outcomes. Diagnosis of thyrotoxicosis antecedent to pregnancy was associated with earlier treatment, and 80% of 28 such women were euthyroid by delivery. Conversely, 32 women with a first diagnosis during pregnancy had the preponderance of morbidity, including five of six stillbirths and six of seven cases of heart failure. This group was characterized by a relative delay in gestational age at diagnosis. Preterm delivery, perinatal mortality, and maternal heart failure were more common in women who remained thyrotoxic despite treatment and in those who were never treated. Although we infrequently achieved maintenance doses recommended by most, because there were minimal adverse effects from therapy described here and because uncontrolled thyrotoxicosis caused significant maternal and perinatal morbidity, aggressive medical therapy seems appropriate, especially when pregnancy is advanced.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalAmerican Journal of Obstetrics and Gynecology
Volume160
Issue number1
DOIs
Publication statusPublished - 1989
Externally publishedYes

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Keywords

  • heart failure
  • pregnancy
  • stillbirgh
  • Thyrotoxicosis

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Davis, L., Lucas, M. J., Hankins, G. D. V., Roark, M. L., & Cunningham, F. G. (1989). Thyrotoxicosis complicating pregnancy. American Journal of Obstetrics and Gynecology, 160(1), 63-70. https://doi.org/10.1016/0002-9378(89)90088-4