Risk of recurrent thyrotoxicosis and the incidence of obstetric complications in pregnant women with diffuse toxic goiter

Background. Diffuse toxic goiter (DTG) is a systemic autoimmune disease that results from the production of antibodies to the receptor for thyroid-stimulating hormone (AB-rTSH) of the thyroid gland and presents clinically with thyrotoxicosis syndrome. Thyrotoxicosis of pregnancy negatively affects pregnancy course and outcomes and increases the risk of perinatal complications, which is a serious problem commonly encountered by endocrinologists and obstetrician-gynecologists in their clinical practice. Conservative management of hyperthyroidism in pregnancy is aimed at reducing the risk of threatened preterm birth, preeclampsia, chronic placental insufficiency, prelabor rupture of membranes, and fetal hypoxia and hypotrophy. Objective. The study aimed to investigate the risk of recurrent thyrotoxicosis and the incidence of obstetric complications in pregnant women with DTG. Methods. The study analyzed the results of monitoring thyroid function in 71 pregnant women with a confirmed diagnosis of DTG, and the structure of obstetric complications in the study cohort. Clinical evaluation included thyroid ultrasound and testing for thyroid-stimulating hormone (TSH), free thyroxine (fT4), and serum AB-rTSH. Results. There was a relationship between the serum level of AB-rTSH and the clinical features of DTG in pregnancy. The study evaluated the possibility of using quantitative parameters of AB-rTSH for predicting the risk of recurrent thyrotoxicosis, proposed diagnostic cut-off value for AB-rTSH, which helps identify the appropriate strategy for thyrostatic therapy. Conclusion. The most favorable course of DTG and the best perinatal outcomes were observed in a subgroup of patients with serum AB-rTSH levels below 7.25 IU/l.

diffuse toxic goiter, thyrotoxicosis, antibodies to thyroid-stimulating hormone receptors, pregnancy, newborns