Graves’ Hyperthyroidism and Child-Bearing Women

Should the Approach to Management of Graves' Hyperthyroidism in Women of Child-Bearing Age Be Revised?

In the past/present, Graves disease is routinely treated with antithyroid medications during pregnancy.  A recent Danish study included 817,093 children born from 1996 to 2008 who were treated with antithyroid medication.

Both commonly used anti-thyroid medications (Methimazole and P.T.U) were associated with birth defects: urinary system malformation and malformations in the face and neck region.

In view of these findings, physicians should discuss with their patients with hyperthyroidism that are of child-bearing age several important aspects of future pregnancies:
(a) The first, obvious, one is to avoid pregnancy until Graves' disease is diagnosed and properly treated
(b) The potential risk of congenital malformations resulting from antithyroid drug exposure in the first trimester.

My approach has always been to try to get a definitive treatment of this disease prior to pregnancy, utilizing radioactive iodine or in some cases surgery.  Needless to say, this isn't a popular position for me to take, but in light of this data seems appropriate in retrospect.

Shahzad Ahmad, MD, FACE, ECNU

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