A restrospective analysis of thyroid disease in pregnancy at Chris Hani Baragwanath academic hospital, Soweto, South Africa

• Main Author: Nicolaou, Veronique
• Format: Others
• Language: en
• Published: 2016
• Online Access: http://hdl.handle.net/10539/19486

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.