Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2019; 7(19): 2953-2962
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.2953
Hyperthyroid heart disease in pregnancy: Retrospective analysis of a case series and review of the literature
Dan Shan, Yi Bai, Qiu-He Chen, Yu-Xia Wu, Qian Chen, Ya-Yi Hu
Dan Shan, Qiu-He Chen, Yu-Xia Wu, Qian Chen, Ya-Yi Hu, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Dan Shan, Qiu-He Chen, Yu-Xia Wu, Qian Chen, Ya-Yi Hu, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
Yi Bai, Department of Medical Records Management, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Shan D and Hu YY designed the study and wrote the paper; Bai Y, Chen QH, Wu YX, and Chen Q collected the patients’ clinical data; all authors have read and approved the final version of this manuscript.
Supported by Science and Technology Department of Sichuan Province, No. 2019YJ0086; and Clinical Research Fund of West China Second University Hospital of Sichuan University, No. KL024.
Institutional review board statement: The Ethics Committee of West China Second University Hospital of Sichuan University in Chengdu, China approved our exploration and analysis of these patients’ data.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ya-Yi Hu, MD, PhD, Professor, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, No. 20, Renmin South Road, Section 3, Chengdu 610041, Sichuan Province, China. ya-yihuscu@sina.com
Telephone: +86-28-85501351 Fax: +86-28-85502391
Received: June 18, 2019
Peer-review started: June 22, 2019
First decision: August 1, 2019
Revised: August 20, 2019
Accepted: August 26, 2019
Article in press: August 26, 2019
Published online: October 6, 2019
Abstract
BACKGROUND

Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health. The risk of hyperthyroid heart disease (HHD), even heart failure, is significantly elevated in pregnant women.

AIM

To investigate the clinical characteristics, prognosis, and therapy of HHD in pregnant women.

METHODS

We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu, China, following the approval by the Ethics Committee. We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD. The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system. All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.

RESULTS

A total of 155 patients were diagnosed with thyrotoxicosis, of whom six were diagnosed with HHD. Three of them had regular antenatal care. Two patients were complicated with acute heart failure attacks, and one of them had a stillbirth. Both of these patients had a long history of Graves’ disease with poor treatment compliance. Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis. Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications. Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage. Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.

CONCLUSION

The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD. Improvement in patients’ awareness of thyrotoxicosis is needed.

Keywords: Hyperthyroidism, Heart disease, Pregnancy

Core tip: Hyperthyroidism may pose a great threat to maternal and fetal health and may increase maternal and fetal mortality. Approximately 85% of hyperthyroidism cases result from Graves’ disease. We retrospectively analyzed a case series of pregnant patients with hyperthyroid heart disease from a central referral hospital in Southwest China. The significance of regular monitoring and the application of anti-thyroid treatment are implied. The control of precipitating factors is important for the management of heart failure.