Outcomes Following Thyroid and Parathyroid Surgery in Pregnant Women

Kuy, SreyRam

doi:10.1001/archsurg.2009.48

Cited by 112 publications

(58 citation statements)

References 30 publications

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“…There were no maternal or fetal complications in any of the studies. Recently (2009), a population-based study compared 201 pregnant women who underwent thyroid and parathyroid surgery during pregnancy with 31,155 similarly treated nonpregnant women (256). One hundred sixty-five operations were thyroid related and 46% of the women had thyroid cancer.…”

Section: And Recommendation 51mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

2,054

2,716

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INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

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Section: And Recommendation 51mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

2,054

2,716

View full text Add to dashboard Cite

show abstract

“…Anti-thyroid drugs (ATDs) have been used since the 1940s, and are the preferred treatment during pregnancy. Radio-iodine is absolutely contraindicated [2,3], and thyroidectomy in pregnancy carries increased morbidity compared to non-pregnant women [4] and may also result in increased risk of subsequent fetal thyrotoxicosis [5]. …”

Section: Introductionmentioning

confidence: 99%

Side Effects of Anti-Thyroid Drugs and Their Impact on the Choice of Treatment for Thyrotoxicosis in Pregnancy

Taylor

Vaidya

2012

Eur Thyroid J

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Introduction: Hyperthyroidism in pregnancy is a serious condition and its management is complex. Whilst carbimazole/methimazole (CBZ/MMI) and propylthiouracil (PTU) have similar efficacies in controlling hyperthyroidism, their risk of side effects such as major congenital abnormalities and hepatotoxicity are different. Methods: Various combinations of the terms ‘anti-thyroid drugs’, ‘thionamide’, ‘carbimazole’, ‘methimazole’, ‘propylthiouracil’, ‘pregnancy’, ‘side effects’, ‘agranulocytosis’, ‘birth defects’, ‘congenital malformations’, ‘embryopathy’, ‘aplasia cutis’, ‘hepatotoxicity’, ‘hepatic failure’, ‘maternal’ and ‘fetus’ were used to search MEDLINE and the Cochrane library. The references of retrieved papers were also reviewed. Results: There is increasing evidence for a CBZ/MMI embryopathy, whilst data remain lacking for major congenital abnormalities with PTU. In contrast, PTU is associated with increased risk of severe liver injury. Management strategies to reduce these risks by using PTU in the first trimester and CBZ/MMI in the later trimesters remain untested. Conclusion: More evidence is still needed in defining the relative risks between CBZ/MMI and PTU of major congenital abnormalities and severe liver injury in pregnancy. Studies are also needed to establish the suitability of recent management suggestions in switching from PTU to CBZ/MMI after the first trimester. Major adverse outcomes secondary to CBZ/MMI and PTU are rare, and inadequately treated hyperthyroidism poses a far greater risk.

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“…More recently, Nam reported 6 cases of thyroidectomy during the second trimester with no increase in complications or poor outcomes for the fetus [5]. Kuy et al compared 165 pregnant women who underwent thyroidectomy to over 31,000 non-pregnant thyroidectomies [6]. They found a statistically significant difference in general complications in 11.4% of pregnant patients versus 3.6% in non-pregnant patients.…”

Section: Discussionmentioning

confidence: 99%

Case Report of Multinodular Goiter and Airway Compression in a Preeclamptic Patient

Berg

Gomes²,

Conturie³

et al. 2012

J Anesthesiol Clin Sci

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Outcomes Following Thyroid and Parathyroid Surgery in Pregnant Women

Abstract: Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.

Cited by 112 publications

References 30 publications

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Side Effects of Anti-Thyroid Drugs and Their Impact on the Choice of Treatment for Thyrotoxicosis in Pregnancy

Case Report of Multinodular Goiter and Airway Compression in a Preeclamptic Patient

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