Thyrotoxicosis complicating pregnancy

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

Research output: Contribution to journalArticle

218 Citations (Scopus)

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
StatePublished - 1989
Externally publishedYes

Fingerprint

Thyrotoxicosis
Pregnancy
Heart Failure
Mothers
Morbidity
Therapeutics
Propylthiouracil
Stillbirth
Perinatal Mortality
Pregnancy Outcome
Gestational Age

Keywords

  • heart failure
  • pregnancy
  • stillbirgh
  • Thyrotoxicosis

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Davis, L. E., Lucas, M. J., Hankins, G., 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

Thyrotoxicosis complicating pregnancy. / Davis, Lowell E.; Lucas, Michael J.; Hankins, Gary; Roark, Micki L.; Cunningham, F. Gary.

In: American Journal of Obstetrics and Gynecology, Vol. 160, No. 1, 1989, p. 63-70.

Research output: Contribution to journalArticle

Davis, LE, Lucas, MJ, Hankins, G, Roark, ML & Cunningham, FG 1989, 'Thyrotoxicosis complicating pregnancy', American Journal of Obstetrics and Gynecology, vol. 160, no. 1, pp. 63-70. https://doi.org/10.1016/0002-9378(89)90088-4
Davis, Lowell E. ; Lucas, Michael J. ; Hankins, Gary ; Roark, Micki L. ; Cunningham, F. Gary. / Thyrotoxicosis complicating pregnancy. In: American Journal of Obstetrics and Gynecology. 1989 ; Vol. 160, No. 1. pp. 63-70.
@article{8923f2c052704b39822d77a06181dd42,
title = "Thyrotoxicosis complicating pregnancy",
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.",
keywords = "heart failure, pregnancy, stillbirgh, Thyrotoxicosis",
author = "Davis, {Lowell E.} and Lucas, {Michael J.} and Gary Hankins and Roark, {Micki L.} and Cunningham, {F. Gary}",
year = "1989",
doi = "10.1016/0002-9378(89)90088-4",
language = "English (US)",
volume = "160",
pages = "63--70",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Thyrotoxicosis complicating pregnancy

AU - Davis, Lowell E.

AU - Lucas, Michael J.

AU - Hankins, Gary

AU - Roark, Micki L.

AU - Cunningham, F. Gary

PY - 1989

Y1 - 1989

N2 - 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.

AB - 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.

KW - heart failure

KW - pregnancy

KW - stillbirgh

KW - Thyrotoxicosis

UR - http://www.scopus.com/inward/record.url?scp=0024496869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024496869&partnerID=8YFLogxK

U2 - 10.1016/0002-9378(89)90088-4

DO - 10.1016/0002-9378(89)90088-4

M3 - Article

C2 - 2912104

AN - SCOPUS:0024496869

VL - 160

SP - 63

EP - 70

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 1

ER -