The management of Graves' disease during pregnancy

The management of the pregnant patient with Graves' thyrotoxicosis remains a contested issue. A retrospective review of our records from 1960 through 1979 involving 25 pregnant women with thyrotoxicosis was performed. Our 25 patients were divided into three management groups, six being managed medically, ten surgically and nine with a combination of medical and surgical therapy. Of the six patients managed medically, four were delivered of term infants and two had premature deliveries. Agranulocytosis developed in one of these women and one infant had a fetal goiter. Of the ten patients surgically managed, three underwent spontaneous abortions, four were delivered of term infants and two had premature deliveries. Of the nine patients who failed to respond to medical treatment and subsequently underwent operation, eight were delivered of term infants. Of the 19 surgically treated patients, one patient had permanent injury to the recurrent laryngeal nerve and one had temporary hypoparathyroidism. The combination of thyrotoxicosis and pregnancy is uncommon, but it requires attentive treatment when diagnosed. There are several treatment alternatives basically following either a medical or surgical approach. There appears to be no clear-cut advantage to either choice, both in the literature or in our limited series. We conclude that either choice is safe and effective.