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Gestational transient thyrotoxicosis

Definition
Gestational transient thyrotoxicosis refers to non-autoimmune hyperthyroidism in pregnant women, and is associated with hyperemesis gravidarum.
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Pathophysiology
Gestational transient thyrotoxicosis is caused by alterations in thyroid function associated with pregnancy, such as elevation of thyroxine binding globulin, increased iodine clearance in kidneys, and stimulation of the thyroid gland by hCG.
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Epidemiology
In Europe, the prevalence of gestational transient thyrotoxicosis at 8-14 weeks of pregnancy is estimated at 2-3%. In Asian women, the prevalence is higher and estimated at 11%.
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Disease course
Gestational transient thyrotoxicosis presents with signs and symptoms of hyperthyroidism and elevation of thyroid hormone in women with negative thyroid-receptor antibodies and no history of hyperthyroidism.
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Prognosis and risk of recurrence
Overt hyperthyroidism during pregnancy can lead to poor maternal and fetal outcomes. Maternal complications of pregnancy associated with hyperthyroidism include pre-term delivery, miscarriage, hypertension, and HF. The fetal and neonatal complications of maternal hyperthyroidism include goiter formation and hyperthyroidism, which can lead to intrauterine growth restriction and failure to thrive in the neonate.
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Key sources
The following summarized guidelines for the management of gestational transient thyrotoxicosis are prepared by our editorial team based on guidelines from the American Thyroid Association (ATA 2017).
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Guidelines

1.Medical management

Supportive care: provide supportive therapy, management of dehydration, and hospitalization if needed in women with abnormal maternal thyroid tests attributable to gestational transient thyrotoxicosis.
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