Management of thyroid disease in pregnancy

Thyroid disease occurs in pregnant at the rate of 0.2-0.6%. Graves' disease is the most common thyroid disorder in our pregnant patients. Thyroid disease is suspected if a significant goitre is detected during pregnancy. Confirmation by thyroid function tests is necessary but their interpretation requires an understanding of changes in the maternal thyroid physiology. Pharmacotherapy with the thionamides is the treatment of choice. Changes in dosage are influenced by the effect of pregnancy on the disease and the optimal level of control for the mother and the foetus. The dose is best titrated against the free thyroxine index or free thyroxine level. The outcome of pregnancy depends on early diagnosis and skillful manipulation of antithyroid drugs.