Pregnancy with hyperthyroidism.

OBJECTIVE

The purpose of the study was (i) to diagnose the pregnant women suffering from hyperthyroidism by differentiating their symptoms from normal pregnancy and confirming this disease biochemically and (ii) to treat such patients medically to achieve euthyroid state of the mother while monitoring the developing fetus for better obstetrical outcome.

DESIGN

A descriptive comparative study.

PLACE AND DURATION OF STUDY

This was a hospital-based study carried out on the patients presented at Federal Government Services Hospital, Islamabad from 1997 to 1998.

SUBJECTS AND METHODS

A total of 30 patients in reproductive age group, suffering from hyperthyroidism with pregnancy, were studied. Patients were recruited in the study in their first trimester having no associated medical problems. The patients were divided into two groups. Group I patients were diagnosed for hyperthyroidism for the first time during pregnancy by biochemical methods. These patients were treated medically. After treatment effects on their previous obstetrical complications, general health and fetal well-being were monitored. The group II patients were already under medical treatment and served as control. Their thyroid status in all trimesters, types of medicine, dose adjustment and maternal and fetal well-being were compared with the patients of group I. The patients of both the groups were treated medically with beta blockers and anti-thyroid drugs mainly carbimazole. For fetal monitoring, ultrasonography (USG) and cardiotocography (CTG) were carried out.

RESULTS

The most common type of hyperthyroidism, in patients of both the groups, was toxic nodular goiter that affected 70% of the patients. The most common previous obstetrical complication in patients of both the groups was abortion (85.7%), followed by premature labour (7%). Carbimazole was the drug of choice given to 70% and 60% patients of group I and group II respectively. Having achieved euthyroid state, dose reduction was possible in 65% patients of group I and 83% patients of group II.

CONCLUSION

Euthyroid state in mothers, by the time of delivery, can be easily achieved with antithyroid drugs and b blockers and the aim to improve obstetrical outcome can be successfully achieved. Hence obstetrical complications, which otherwise affect 93.33% of such patients, can easily be avoided through medical treatment.