Graves Hyperthyroidism and Pregnancy: A Clinical Update

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


Endocr Pract. 2010;16(1):118-129. 

In This Article

Postpartum Care

As described in the natural history of Graves disease, many patients experience recurrent hyperthyroidism in the first few months of the postpartum period. Continuation of antithyroid medication, even with breastfeeding, and frequent laboratory examinations are strongly recommended. Patients should have thyroid function tests (TSH and free T4) performed at regular intervals for the first year following delivery, starting at 6 weeks' postpartum. It is important to distinguish between relapsed Graves disease and the hyperthyroid phase of postpartum thyroiditis, which usually resolves without antithyroid drug therapy.[12] If the patient is not breastfeeding, 131I uptake scan may help distinguish between the 2 entities. Iodine 131 uptake is suppressed in postpartum thyroiditis and elevated in Graves disease. Women with Graves hyperthyroidism in remission before pregnancy have a high probability of recurrence between 4 and 12 months after delivery.[56]