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

Clinical Presentation of Graves Hyperthyroidism

The clinical presentation of Graves hyperthyroidism in women of reproductive age spans a broad spectrum. Women with a history of Graves disease may present with 5 different scenarios:

  1. Initial diagnosis of hyperthyroidism during pregnancy, with most patients having symptoms antedating pregnancy.

  2. Previous diagnosis of hyperthyroidism, with the patient on antithyroid therapy at the time of conception.

  3. Recurrence of hyperthyroidism in patients in remission from antithyroid therapy.

  4. Previous treatment of hyperthyroidism by surgery or 131I.

  5. Previous birth of an infant with thyroid dysfunction.

Signs and symptoms of Graves hyperthyroidism in pregnancy are similar to those in affected nonpregnant persons. However, some of these symptoms may be synonymous with those seen in normal pregnancy such as heat intolerance, shortness of breath, insomnia, slightly elevated pulse rate, and decreased exercise tolerance. Goiter is always present. Careful examination of the eyes may reveal signs of exophthalmopathy. Several cases of thyroid storm and congestive heart failure have been reported.

The natural history of Graves hyperthyroidism is exacerbation of symptoms during the first trimester of pregnancy due to additive effects of human chorionic gonadotropin stimulation of the TSH receptor. During the second half of pregnancy, these symptoms may lessen in severity because of immunologic alterations in pregnancy, and consequently, the requirement for antithyroid drugs decreases. Symptoms may worsen again during the postpartum period because Graves disease is exacerbated or postpartum thyrotoxicosis develops.[12]