Faculty Opinions recommendation of Antithyroid drug therapy in pregnancy and risk of congenital anomalies: Systematic review and meta-analysis.

We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

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Antithyroid drug therapy in pregnancy: a review of guideline recommendations

Expert Review of Endocrinology & Metabolism ◽

10.1080/17446651.2017.1338944 ◽

2017 ◽

Vol 12 (4) ◽

pp. 269-278 ◽

Cited By ~ 2

Author(s):

Ishrat Khan ◽

Onyebuchi Okosieme ◽

John Lazarus

Keyword(s):

Drug Therapy ◽

Antithyroid Drug ◽

Antithyroid Drug Therapy ◽

In Pregnancy

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The impact of thyroid function in women at the reproductive age: infertility, pregnancy and the postpartum period

Orvosi Hetilap ◽

10.1556/oh.2013.29774 ◽

2013 ◽

Vol 154 (51) ◽

pp. 2017-2023 ◽

Cited By ~ 2

Author(s):

Gábor Speer

Keyword(s):

Clinical Practice ◽

Drug Therapy ◽

Practice Guidelines ◽

Thyroid Dysfunction ◽

Antithyroid Drug ◽

Reproductive Age ◽

Antithyroid Drug Therapy ◽

Pregnancy And Postpartum ◽

The Impact ◽

In Pregnancy

This article reviews the management and diagnosis of thyroid dysfunction during pregnancy and postpartum, which was published by any of the endocrine societies in 2012. The author presents human data based on these clinical practice guidelines, however, there are also many unresolved questions. Especially, there are inconsistencies about screening using plasma TSH measurement. In pregnancy the main causes of hyperthyroidism are Graves’s disease and gestational transient thyrotoxicosis. Generally, gestational transient thyrotoxicosis does not require medication, whereas Graves’s disease needs antithyroid drug therapy. Postpartum thyroiditis occurs more frequently in antithyroid peroxidase-positive women, who should be screened using serum thyrotropin measurements at 6 to 12 gestation weeks and at 3 and 6 months postpartum. Because overt maternal hypothyroidism, due to autoimmune pathophysioloical mechanisms, negatively affects the fetus, timely recognition and treatment are important. The subclinical form of maternal hypothyroidism should also be treated. A link between thyroid dysfunction and infertility has been warranted. Orv. Hetil., 2013, 154(51), 2017–2023.

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Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

Acta Endocrinologica ◽

10.1530/eje-08-0663 ◽

2009 ◽

Vol 160 (1) ◽

pp. 1-8 ◽

Cited By ~ 92

Author(s):

Peter Laurberg ◽

Claire Bournaud ◽

Jesper Karmisholt ◽

Jacques Orgiazzi

Keyword(s):

Drug Therapy ◽

Thyroid Function ◽

Antithyroid Drug ◽

Autoimmune Disorder ◽

Antithyroid Drugs ◽

Graves Disease ◽

Limited Effect ◽

Antithyroid Drug Therapy ◽

Maternal Thyroid ◽

In Pregnancy

Graves' disease is a common autoimmune disorder in women in fertile ages. The hyperthyroidism is causedby generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves' hyperthyroidism but also in her foetus.The review includes two cases illustrating some of the problems in managing Graves' disease in pregnancy.Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (l-T4) given to the mother will have only a limited effect in the foetus.Surgical thyroidectomy of patients with Graves' hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomy+withdrawal of antithyroid medication+l-T4 replacement of the mother involves a high risk of foetal hyperthyroidism.ConclusionAntithyroid drug therapy of pregnant women with Graves' hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal hyperthyroidism.

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