Pre-conception counselling in graves' disease.

Area of Science:

• Endocrinology
• Obstetrics
• Neonatology

Background:

• Untreated Graves' hyperthyroidism poses significant risks to the mother, fetus, and neonate during pregnancy.
• Effective management of maternal thyroid disorders is essential for optimal pregnancy outcomes.

Purpose of the Study:

• To emphasize the importance of pre-conception counseling for women with Graves' hyperthyroidism.
• To discuss optimal treatment strategies for Graves' hyperthyroidism in women planning pregnancy.
• To review the risks and benefits of various treatment modalities during gestation and breastfeeding.

Main Methods:

• Review of current literature and clinical guidelines regarding Graves' hyperthyroidism management in pregnancy.
• Discussion of treatment options including medical therapy (antithyroid drugs), radioiodine therapy, and surgery.
• Analysis of risks associated with antithyroid drugs (propylthiouracil, methimazole, carbimazole) and their use in different trimesters.

Main Results:

• Radioiodine therapy is generally avoided due to persistent thyrotropin receptor antibodies, increasing the risk of fetal/neonatal hyperthyroidism.
• Medical or surgical treatments are preferred for managing Graves' hyperthyroidism preconception and during pregnancy.
• Achieving a TSH level <2.5 mIU/l is critical for women on levothyroxine (LT4) before conception.
• Antithyroid drugs carry risks: propylthiouracil (PTU) has a low risk of liver disease, while methimazole/carbimazole pose a risk of embryopathy.
• PTU is preferred in the first trimester; other thionamides are alternatives if PTU is unavailable.
• Breastfeeding is permissible with low-dose antithyroid medication.

Conclusions:

• Pre-conception counseling is vital for optimizing maternal and fetal health in Graves' hyperthyroidism.
• Careful selection of treatment modality, considering risks and benefits, ensures euthyroid status for mother and fetus.
• Neonatal hyperthyroidism can be effectively managed, and postpartum thyroid monitoring is essential.