Graves Hyperthyroidism and Pregnancy: A Clinical Update

Komal Patil-Sisodia, MD; Jorge H. Mestman, MD

Disclosures

Endocr Pract. 2010;16(1):118-129. 

In This Article

Abstract and Introduction

ABSTRACT

Objective: To provide a clinical update on Graves' hyperthyroidism and pregnancy with a focus on treatment with antithyroid drugs.
Methods: We searched the English-language literature for studies published between 1929 and 2009 related to management of hyperthyroidism in pregnancy. In this review, we discuss differential diagnosis of hyperthyroidism, management, importance of early diagnosis, and importance of achieving proper control to avoid maternal and fetal complications.
Results: Diagnosing hyperthyroidism during pregnancy can be challenging because many of the signs and symptoms are similar to normal physiologic changes that occur in pregnancy. Patients with Graves disease require prompt treatment with antithyroid drugs and should undergo frequent monitoring for signs of fetal and maternal hyperthyroidism and hypothyroidism. Rates of maternal and perinatal complications are directly related to control of hyperthyroidism in the mother. Thyroid receptor antibodies should be assessed in all women with hyperthyroidism to help predict and reduce the risk of fetal or neonatal hyperthyroidism or hypothyroidism. The maternal thyroxine level should be kept in the upper third of the reference range or just above normal, using the lowest possible antithyroid drug dosage. Hyperthyroidism may recur in the postpartum period as Graves disease or postpartum thyroiditis; thus, it is prudent to evaluate thyroid function 6 weeks after delivery. Preconception counseling, a multidisciplinary approach to care, and patient education regarding potential maternal and fetal complications that can occur with different types of treatment are important.
Conclusion: Preconception counseling and a multifaceted approach to care by the endocrinologist and the obstetric team are imperative for a successful pregnancy in women with Graves hyperthyroidism.

Introduction

The development of thyrotoxicosis during pregnancy affects up to 0.1% to 0.4% of pregnancies.[1–3] Graves disease is the overwhelming autoimmune cause of thyrotoxicosis during pregnancy and may result in maternal and fetal complications if not properly controlled. Frequent monitoring of the patient by clinical and laboratory examination and a multidisciplinary approach to care are of utmost importance, as is education of the patient regarding the potential maternal and fetal complications associated with overtreatment or undertreatment of hyperthyroidism.

We searched the English-language literature for studies published between 1929 and 2009 related to management of hyperthyroidism in pregnancy. In this review, we discuss differential diagnosis of hyperthyroidism, management, importance of early diagnosis, and importance of achieving proper control to avoid maternal and fetal complications.

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