Management of Thyrotoxicosis

Preconception, Pregnancy, and the Postpartum Period

Elizabeth N. Pearce, MD, MSc, FACE


Endocr Pract. 2019;25(1):62-68. 

In This Article


The diagnosis and management of thyrotoxicosis in the peripregnancy period can be challenging. It is essential to understand the underlying etiology for thyrotoxicosis in order to recommend appropriate therapy. In making management decisions, it is important to weigh the risks and benefits of treatments not just for the mother but also the fetus and breastfed infant. A team approach to management, with close collaboration between endocrinologists, maternal-fetal medicine specialists, and neonatologists, is essential. There are currently many unanswered questions regarding the optimal treatment of pregnant women with thyrotoxicosis. Additional studies will be needed to better understand the effects of maternal hyperthyroidism in pregnancy on child neurodevelopment, the optimal free T4 level for treated hyperthyroid patients, how to select women with GD who may safely discontinue antithyroid drug at the beginning of pregnancy, and whether or when to switch back from PTU to MMI in treated hyperthyroid patients after the period of organogenesis.