Graves'-Basedow disease in pregnancy

P. Laurberg; S. L. Andersen

doi:10.1055/s-0037-1616612

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2015; 54(03): 106-111
DOI: 10.1055/s-0037-1616612

Innovation Schilddrüse

Schattauer GmbH

Graves'-Basedow disease in pregnancy

New trends in the management and guidance to reduce the risk of birth defects caused by antithyroid drugsGraves-Basedow-Krankheit in der SchwangerschaftNeue Trends im Management zur Reduktion des Risikos für Geburtsfehler durch Thyreostatika

P. Laurberg

¹Department of Endocrinology Aalborg University Hospital, Aalborg, Denmark

²Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

,

S. L. Andersen

¹Department of Endocrinology Aalborg University Hospital, Aalborg, Denmark

²Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

³Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

› Author Affiliations

Abstract

Summary

Thyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth.

A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.

Zusammenfassung

Schilddrüsenhormone sind notwendige Entwicklungsfaktoren, eine Schilddrüsenfunktionsstörung der Mutter kann Komplikationen in der Schwangerschaft sowie Krankheiten beim Fötus/Kind auslösen. In dieser übersicht diskutieren wir neue Daten zur Inzidenz des Morbus Basedow vor, während und nach einer Schwangerschaft und wie eine Hyperthyreose das Risiko für Spontanaborte oder Totgeburten beeinflusst.

Besondere Sorge bei Schwangeren gilt den potenziellen Nebenwirkungen von Thyreostatika. Zum einen sind dies allergische/toxische Reaktionen, die mit und ohne Schwangerschaft ähnlich zu sein scheinen, zum anderen wird der Fötus unter Thyreostatikabehandlung tendenziell übertherapiert, während die Mutter mit M. Basedow euthyreot wird. Zur Vermeidung einer fötalen Hypothyreose sollte die niedrigste noch wirksame Dosis des Thyreostatikums angewendet werden, um die mütterliche Schilddrüsenfunktion, bei niedrigem Serum-TSH, im oberen Referenzbereich zu halten.

Geburtsfehler nach der Einnahme von Methimazol (MMI) (oder seinem Prodrug Carbimazol) galten als sehr selten, auch mit Propyl - thiouracil (PTU) wurde bislang kein Risiko assoziiert. In einer aktuellen, landesweiten dänischen Studie wurde jedoch festgestellt, dass 1/30 Kindern, die in der Frühschwangerschaft MMI ausgesetzt waren, damit verbundene Geburtsfehler aufwies, viele davon schwerwiegend. Die Exposition gegenüber PTU war mit weniger schweren Defekten bei 1/40 Kindern verbunden. Vorschläge zur Senkung des Risikos von Thyreostatika bedingten Geburtsfehlern werden präsentiert.

Keywords

Antithyroid drugs - Basedow's disease - birth defects - epidemiology - incidence - Graves' disease - pregnancy - spontaneous abortion - stillbirth - thyroid disease - thy rotoxicosis

Schlüsselwörter

Thyreostatika - Morbus Basedow - Geburtsfehler - Epidemiologie - Inzidenz - Schwangerschaft - Spontanabort - Totgeburt - Schilddrüsenerkrankung - Hyperthyreose

Full Text

References

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