| Summary: | A research report submitted to the University of the Witwatersrand,
Johannesburg in fulfillment for the requirements of the degree of Master
of Medicine 2015. === Background
Hyperthyroidism occurs in 0.1-0.4% of pregnancies, Graves’ disease
accounting for 85% of cases. Hypothyroidism occurs in 2.3-3.5% of
pregnancies, of which overt hypothyroidism accounts for 0.3-0.5% and
subclinical hypothyroidism for 2-3%. Thyroid disease in pregnancy is known to
be associated with adverse outcomes for both mother and foetus.
No studies have been reported examining the prevalence, spectrum and
management of thyroid disorders in pregnancy in the Black population of South
Africa.
Objectives
To examine thyroid disorders in pregnancy at Chris Hani Baragwanath
Academic Hospital (CHBAH) by assessing their underlying causes,
management and outcomes, maternal and neonatal.
Methods
We performed a retrospective review of thyroid disorders in 88 patients, who
attended the Antenatal Endocrine Clinic, from 2004 to 2008. All underwent initial
and follow-up clinical and biochemical assessments. Delivery records were
obtained where available. Thyroid function tests were performed on the
neonates at least 48 hours after delivery.
Results
Fifty-eight (66%) of the 88 patients were hyperthyroid, 23(26%) were
hypothyroid, and 7 (8%) had euthyroid endemic colloid goitres. Forty-eight
(83%) of the 58 hyperthyroid patients had Graves’ disease and, as such was
the commonest thyroid disorder encountered. Overall it was estimated to be
present in 0.06% of all pregnancies at CHBAH versus 0.2-0.4% reported by
others. Almost half of the hypothyroid patients were due to I131 ablation for
Graves’ disease. Eighty percent of the Graves’ disease and 83% of the
hypothyroid patients were rendered euthyroid before delivery. A single fatal
maternal outcome was due to uterine rupture. Six intra-partum foetal losses
occurred. Among the newborns there was one case of a tracheo-oesophageal
fistula and one of neonatal thyrotoxicosis.
Conclusion
This is the first report in Africa examining thyroid diseases in pregnancy.
Thyroid disorders were less frequent than reported by others. Graves disease
was the commonest disorder that presented to our Antenatal Endocrine Clinic.
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