Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa

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dc.contributor.authorVan der Made, Ten_ZA
dc.contributor.authorVan der Vyver, Men_Za
dc.contributor.authorConradie-Smit, Men_ZA
dc.contributor.authorConradie, Magdaen_ZA
dc.date.accessioned2023-03-22T13:28:55Zen_ZA
dc.date.available2023-03-22T13:28:55Zen_ZA
dc.date.issued2021-08-31en_ZA
dc.descriptionCITATION: Van der Made, T. et al. 2021. Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa. Journal of Endocrinology, Metabolism and Diabetes of South Africa 2021; 26(1):1–8. doi.10.1080/16089677.2020.1831740en_ZA
dc.descriptionThe original publication is available at: ajolen_ZA
dc.description.abstractBackground: The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. Aims: The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) were studied. Methods: Women admitted for HG, who underwent thyroid function evaluation between 1 August 2016 and 30 April 2019, were studied. Laboratory data included baseline human chorionic gonadotropin (hCG) and baseline (t1), discharge (t2) and follow-up (t3) thyroid function tests (thyroid stimulating hormone [TSH] and free thyroxin [fT4]). Available TSH receptor antibody status was assessed. Results: Eighty-two patients were included. The incidence of thyrotoxicosis was 49% based on local laboratory TSH range and 48% if trimester-specific ranges used. In the majority of normal pregnancies, thyrotoxicosis was hCG-mediated (72.5%), 15% were confirmed to have Graves’ disease and 12% had a molar pregnancy. Very high fT4 levels (> 40 pmol/l) at baseline [t1] were documented in 24% of women with hCG-mediated thyrotoxicosis. Clinical features were absent in a third of women with Graves’ disease and the diagnosis was reliant on positive antibody status. Free T4 values declined from (t1) to later in gestation (t3) (p < 0.001). Conclusion: The incidence of thyrotoxicosis in women with HG is high. Free-T4 values decrease with clinical stabilisation of HG, suggesting a contribution of dehydration to the large variation in baseline fT4 measurements. Testing for TSH-receptor antibodies should be considered in women with TSH < 0.01 pmol/l and persistent fT4 elevation on follow-up. Final review of thyroid function should be performed after 15 weeks’ gestation.en_ZA
dc.description.versionPublisher’s versionen_ZA
dc.format.extent8 pagesen_ZA
dc.identifier.issn1608-9677 (print)en_ZA
dc.identifier.issn2220-1009 (online)en_ZA
dc.identifier.otherdoi.10.1080/16089677.2020.1831740en_ZA
dc.identifier.otherdoi.10.1080/16089677.2020.1831740en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/126696en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherAJOLen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectHyperthyroidismen_ZA
dc.subjectGraves’ diseaseen_ZA
dc.subjectChorionic gonadotropinsen_ZA
dc.subjectHyperemesis gravidarumen_ZA
dc.subjectHypothalamic-pituitary-thyroid axisen_ZA
dc.titlePrevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africaen_ZA
dc.typeArticleen_ZA
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