REVIEW OF RELATED LITERATURE/STUDIES

Maternal hyperthyroidism is a relative rare disorder, which can seriously

complicate pregnancy in each of its periods. The most common cause of
hyperthyroidism during pregnancy is Graves' disease (Martinez, R., De Groot, L., &
Mestman, J., 2018). Graves' disease is a complex autoimmune disorder, characterized
by autoantibodies that activate the thyroid stimulating hormone receptor. These
autoantibodies cross the placenta and can cause fetal and neonatal thyroid dysfunction
even when the mother herself is in an euthyroid condition. Exceptional, hyperthyroidism
in pregnancy has a different cause other than Graves' disease like hyperemesis
gravidarum, gestational transient hyperthyroidism, hydatiform mole, choriocarcinoma
(American College of Obstetricians and Gynecologists, 2016). Establishing the correct
diagnosis and effectively managing Graves’ Hyperthyroidism in pregnancy was
challenging; pregnancy alters thyroid physiology and laboratory testing, antithyroid
drugs are associated with teratogenicity, and maternal, fetal, and newborn
complications are directly related to control of Graves’ Hyperthyroidism and in a few
cases to the levels of serum maternal thyroid-stimulating immunoglobulin. Fetal and
neonatal hyperthyroidism occurs in 1% to 5% of women with active or a past history of
Graves’ Hyperthyroidism and is associated with increased fetal/neonatal morbidity and
mortality if not diagnosed and treated. All women of reproductive age with Graves’
Hyperthyroidism or past history of Graves’ Hyperthyroidism received a preconception
counseling (Nguyen, C.T., Sasso, E.B., Barton, L. et al., 2018). Establishing the
diagnosis of Graves’ hyperthyroidism early, maintaining euthyroidism, and achieving a
serum total T4 in the upper limit of normal throughout pregnancy is key to reducing the
risk of maternal, fetal, and newborn complications. The key to a successful pregnancy
begins with preconception counseling. Nguyen et al. (2018) further described that
counseling should take into consideration the woman’s desired timeline to conception
and include a discussion of the risks and benefits of all treatment options such as
medical therapy, 131-I radioactive iodine ablation, and surgery. According to the Mayo
Foundation for Medical Education and Research (MFMER,2020), women with Graves’
Hyperthyroidism should be advised to postpone conception and use contraception until
Graves’ Hyperthyroidism is controlled. Women with difficult to control Graves’
Hyperthyroidism on high doses of anti-thyroid drug therapy should consider definitive
therapy either radioactive iodine ablation or surgery prior to conception.

References:

American College of Obstetricians and Gynecologists. (2016). Management of

hyperthyroidism in pregnancy. Retrieved April 21, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018974/

Martinez, R., De Groot, L., & Mestman, J. (2018, July). Hyperthyroidism and Pregnancy.
Retrieved April 21, 2020, from https://www.hormone.org/diseases-and-
conditions/pregnancy-and-thyroid-disease/hyperthyroidism-and-pregnancy

Mayo Foundation for Medical Education and Research. (2020, January 7).
Hyperthyroidism (overactive thyroid). Retrieved April 21, 2020, from
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-
20373659

Nguyen, C. T., Sasso, E. B., & Barton, L. et.al. (2018). Graves’ hyperthyroidism in
pregnancy: a clinical review. Retrieved April 21, 2020, from
https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-018-0054-7