A Clinical Analysis Of65Cases Of Hyperemesis Gravidarum With Gestational Transient Thyrotoxicosis

I Objective]Hyperemesis gravidarum (HG) is a complication of early pregnancy characterized by persistent vomiting, weight loss of more than5%, ketonuria and dehydration. Gestational thyrotoxicosis is a common endocrine disorder during pregnancy, which presenting as hypermetabolism including tachycardia, increased perspiration, anxiety, irritability, weight loss, reduced thyroid stimulating hormone (TSH) levels, and increased triiodothyronine (T3) and tetraiodothyronine (T4) levels. Gestational transient thyrotoxicosis (GTT) results from inappropriate hCG secretion and is a common form of hyperthyroidism in the first trimester of pregnancy. We investigated thyroid function in patients with hyperemesis gravidarum(HG) and analyze the impact on pregnancy outcome of gestational transient thyrotoxicosis (GTT) of hyperemesis gravidarum.[Methods]143patients with hyperemesis gravidarum who required hospitalization for relydration from January2010to Spetember2012had serum thyroid-stimulating hormone(TSH), free T3(FT3), total T3(TT3), free T4(FT4),total T4(TT4), thyroid globulin antibody(TgAb), thyroid peroxidase antibody(TPOAb), and human chorionic gonadotrohin(hCG) test, followed the course of TSH、FT3、FT4and the outcome of pregnancy who had an abnormal thyroid function.[Results]The total prevalence of thyrotoxicosis was48.3%in patients with hyperemesis gravidarum. GTT was the main form (45.5%). When serum hCG was>80000IU/L, GTT increased significantly; When serum hCG was between80000and140000IU/L, subclinical GTT increased significantly in patients with HG When serum hCG was>180000IU/L, clinical GTT increased significantly. followed the course of TSH、FT3、 FT4in34cases of hyperemesis gravidarum with gestational transient thyrotoxicosis (GTT),we found the thyroid function was normalized by the second trimester. Follow the pregnancy outcome of65cases of hyperemesis gravidarum with GTT, two underwent abortion due to unplanned pregnancies, two delivered prematurely, two had macrosomia, and no other complications occurred. Newborns (n=63) delivered by patients with GTT had normal TSH.[Conclusions]GTT is common in HG. The severity of GTT is related with serum hCG level. In patients with HG and GTT, thyroid function normalises by the second trimester without anti-thyroid treatment. GTT did not affect pregnancy outcome.