Graves’ Disease & Pregnancy

Vivekananda Institute of
Medical Sciences
Kolkata
Graves’ Disease & Pregnancy
Foetal Problems
Higher incidence of:-
Abortion
Preterm delivery
Low birth wt. Infants
Congenital anomalies
Neonatal mortality
Graves’ Disease & Pregnancy

Maternal problems

 Heart failure
 Eclampsia
 Thyroid storm
 Graves’ Disease & Pregnancy
 Nervousness
 Irritability
 Warm skin
 Tremor hand
 Wide pulse pressure
 Palmer Erythema
 Sweating
 Goitre
 Fatigue
 Wt.loss(1st trimester)
Graves’ Disease & Pregnancy
(Clinical)

 Wt. loss inspite good

appetite
 Large goitre with Bruit
 Ophthalmopathy
 P/H/O Graves’ Disease
Graves’ Disease & Pregnancy
Laboratory

TSH
F T4
T4 > 20 mcg/dl
TSH Ab
**Isotope test * Never *
Graves’ Disease & Pregnancy

TREATMENT

• Known Graves’ Disease may improve during

pregnancy
• Mild thyrotoxicosis may not need treatment
 Graves’ Disease & Pregnancy
TREATMENT

Antithyroid drugs Cross placenta

Goitre /hypothyroidism in foetus

Avoid large dose of PTU(< 300mg) and CMZ or

MMI( <30mg). PTU is preferable
Graves’ Disease & Pregnancy

Antithyroid drugs

‘Block & replace’ regimen is not

recommended in Pregnancy
 Graves’ Disease & Pregnancy
Treatment goal

TSH 0.45 to 4.5

F T4 Normal range
T4 10 to 16 mcg/dl

If large dose of antithyroid is reqd.

Surgery
Graves’ Disease & Pregnancy
SURGICAL TREATMENT

• Time--- 2nd Trimester

• Close monitoring ( every 1 to 2 wks.)
• Short term high dose antithyroids before
surgery
• Beta blockers
• Lugol’s Iodine (may cause large goitre in
foetus)
Graves’ Disease & Pregnancy

TFT of Infant

At birth
After 6 wks.
Graves’ Disease & Pregnancy
Neonatal thyrotoxicosis

Maternal TSH Ab > 5 times

Predicts Neonatal thyrotoxicosis

Fetus monitored closely for 3 months

β-blockers may be reqd.

Graves’ Disease & Pregnancy

Post Partum Period

Avoid large dose of Antithyroid

drugs
I 131 contraindicated
Graves' Disease and Pregnancy
VIMS,Kolkata
18 patients 24 Pregnancies
Foetal loss 7
Spont.ab. 3
MTP 3 All pts.on CMZ

Still born 1

CMZ 10
PTU 1 Sucessful outcome

Surgery 3
No t/t 3
Graves’ Disease & Pregnancy

Planned pregnancy is desirable

o Restore Euthyroid state before pregnancy

o Curative treatment is the best
o Wait 1 yr. after I 131 treatment