Graves' Disease & Pregnancy

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 TSH

> 20 mcg/dl 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 18 patients

VIMS,Kolkata 24 Pregnancies

Foetal loss

7

Spont.ab.

3

MTP

3

Still born

1

CMZ

10

PTU

1

Surgery

3

No t/t

3

All pts.on CMZ

Sucessful outcome

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