Study on the correlation between hypothalamic tyrosine hydroxylase level and sex hormone and thyroid hormone level in patients with hyperthyroidism in the third trimester of pregnancy

Abstract

Abstract
Background: The risk of maternal-fetal problems is increased when the ovaries are hyperthyroid. Potentially, anti-thyroid medication (ATD) can be used to lessen the teratogenic consequences and the neonatal-fetal hyperthyroidism. Although the negative effects of antithyroid medicines are less common, they nevertheless occur in 1-2.5 percent of individuals. This includes rashes, irritation, irregular hair loss, and so on. TSH is the most sensitive thyroid status measure due to the complicated inverse relationship between pituitary-derived thyroid stimulating hormone (TSH) and thyroid hormones free thyroxine (FT4) and free triiodothyronine (FT3).
Objective: Anti-thyroid medication treatment and thyroid function regulation during pregnancy were examined in this study. We also assessed the effects of the pregnant woman's hyperthyroidism.
Material and methods: Among the 29 women (average age 30±5 years) who had hyperthyroidism tested before and during pregnancy, 36 instances were studied. The control group consisted of approximately 39 euthyroid patients.
Results: Out of the 36 patients, Around 26 women have Graves disease, and 1 patient has a hyperfunctioning autonomous nodule. Two patients have thyrotoxicosis. Methimazole was used to treat 78.5 percent (22 out of the 28 patients) of pregnant women; propylthiouracil, or PTU, was used to treat 7.1 percent (2) of pregnant women; methimazole was switched to PTU in 14.2 percent (4) of patients; and eight pregnant women received no medication.
Discussions: Patients are diagnosed with one of the eight Graves illnesses during or just before pregnancy, when the foetus is exposed to uncontrolled hyperthyroidism. Abortion occurred at five weeks gestation and preterm delivery occurred at 32 weeks, with a 3.4 percent infant mortality rate in the first 24 hours and one premature birth at 32 weeks gestational age. It was revealed that in women treated for more than 6 months after conception, antithyroid dosages are much lower than in the first trimester of pregnancy (T1), with everyone on less than 10 mg/day of Methimazole (relapse occurred in 14.2% of cases, and in 55% of T3 cases). In 35%, 37%, and 22% of first trimester, second trimester, and third trimester pregnant cases, respectively, thyroid stimulating hormone levels were normal. There have been no recorded delivery complications, however one foetal birth has been attributed to the umbilical cord knot. The mean birth weights of the treated and untreated groups were similar. The median length of pregnancy is 32.6 months in 83 percent of Graves disease patients.
Conclusion: In hypothyroid pregnancy with prolonged ATD treatment prior to conception, drugs can be withdrawn in the T1 in 40% of patients, thyroid function control was much better, and foetal problems were relatively less in comparison to pregnancy cases. TSH and FT4 levels must be monitored to ensure proper thyroid function during pregnancy. [Ethiop. J. Health Dev.2022;36(3):00-00]
Keywords: Graves’ disease; hyperthyroidism; antithyroid drug; drug withdrawal; pregnancy; birth defects; post-partum recurrence.