Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.2953
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
Processing time: 104 Days and 1.9 Hours
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.
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.
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.
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.
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.
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.
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.