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
ARTICLE HIGHLIGHTS
Research background

In pregnant women, the prevalence of hyperthyroidism is approximately 0.05% to 3.0%, and most of these cases are caused by Graves’ disease. If the clinical management of hyperthyroidism is not provided in time, it could lead to hyperthyroid heart disease (HHD), which is a serious condition in pregnant women that has life-threatening risks.

Research motivation

The investigation of the clinical characteristics of pregnant patients with HHD can improve our understanding of this serious complication. Given that pregnancy can increase the hemodynamic workload and is a challenge to the cardiac function, pregnant women suffer more risks from HHD than the general population.

Research objectives

The main objective of this study was to review the clinical courses of pregnant patients with HHD enrolled in a central referral hospital in Southwest China in order to provide evidence for better management of this serious complication.

Research methods

The electronic medical records system was searched for the collection of patient data. The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained. Follow-up was completed by outpatient clinic visits and telephone interviews.

Research results

During the study period, a total of nearly 70000 women delivered at our hospital. Six patients were diagnosed with HHD. Two patients with a long history of Graves’ disease with poor treatment compliance suffered acute heart failure attacks, one of whom had a stillbirth. Three patients had regular antenatal care, and the prognosis was comparatively better. HHD could be controlled after the application of anti-thyroid drugs and aggressive diuretics and the management of the coexisting complications. Intense monitoring and timely anti-heart failure treatment were important for the prognosis in patients with severe cardiac damage.

Research conclusions

We present the clinical courses of six patients with HHD, and differences in their compliance lead to their different pregnancy outcomes. Making a correct diagnosis and providing a timely intervention are crucial. The regular application of anti-thyroid drugs before and during pregnancy can prevent the development of HHD. Treatments of precipitating factor can relieve the cardiac burden to some extent.

Research perspectives

Due to the retrospective nature of the study and the small sample size, it is difficult to draw reliable conclusions. However, our findings indicate the importance of good treatment compliance, regular antenatal care, and timely treatment in pregnant patients with HHD.