Graves’ hyperthyroidism in pregnancy: a clinical review

BACKGROUND: Graves' hyperthyroidism affects 0.2% of pregnant women. Establishing the correct diagnosis and effectively managing Graves' hyperthyroidism in pregnancy remains a challenge for physicians. MAIN: The goal of this paper is to review the diagnosis and management of Graves' hyperthyroidism in pregnancy. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy-related complications, maternal management, including thyroid storm, anti-thyroid drugs and the complications for mother and fetus, fetal and neonatal thyroid function, neonatal management, and maternal post-partum management. CONCLUSION: Establishing the diagnosis of Graves' hyperthyroidism early, maintaining euthyroidism, and achieving a serum total T4 in the upper limit of normal throughout pregnancy is key to reducing the risk of maternal, fetal, and newborn complications. The key to a successful pregnancy begins with preconception counseling.