Hyperthyroidism and Pregnancy

Pregnancies of mothers with a history of Graves’ hyperthyroidism, previously treated, and those diagnosed at time of pregnancy are at higher risk of maternal and obstetrical complications as compared to a euthyroid population. Preconception patient education and contraception are imperative in women with thyroid disease, during the reproductive age. A medical team including endocrinologists, obstetricians, medical fetal-maternal physicians, anesthesiologists, neonatologist, and pediatric endocrinologists should be available from the time pregnancy is diagnosed. Antithyroid drug (ATD) therapy is the treatment of choice; thyroid surgery is indicated in selective cases. Selection of drug, timing of administration, and close follow-up with proper thyroid tests are essential for a good maternal and fetal outcome. Potential complications of ATD therapy should be considered and discussed with potential parents, as well as the interpretation of serum TRAb titers in detecting and treating thyroid fetal and neonatal disease. Breastfeeding recommendations and postpartum follow-up for a year following delivery is part of the care of a woman with a history of Graves’ hyperthyroidism.