Graves’ disease is an autoimmune condition where the body’s immune system mistakenly attacks the thyroid gland, causing it to produce excessive thyroid hormones, known as hyperthyroidism. While Graves’ disease introduces complexities, a successful pregnancy is generally possible with careful medical management.
Graves’ Disease and Fertility
Uncontrolled Graves’ disease can impact conception. Elevated thyroid hormone levels disrupt menstrual cycles and ovulation, making it challenging to get pregnant. Infertility is more prevalent among women with autoimmune thyroid conditions.
Achieving a euthyroid state (normal thyroid hormone levels) before conception is important for fertility. When thyroid levels are healthy, Graves’ disease typically does not significantly impair fertility. Individuals planning pregnancy should work closely with their healthcare provider to manage their condition effectively.
Managing Graves’ Disease During Pregnancy
Managing Graves’ disease during pregnancy requires a multidisciplinary care team, often including an endocrinologist, a high-risk obstetrician, and potentially a maternal-fetal specialist.
Regular monthly blood tests monitor thyroid hormone levels to ensure stability. These tests guide medication adjustments, frequently needed as pregnancy progresses.
Antithyroid medications are the primary treatment for Graves’ disease during pregnancy. PTU is generally preferred in the first trimester due to concerns about birth defects with MMI. After the first trimester, a switch to MMI is often recommended, as PTU carries a rare risk of liver toxicity. The goal is to use the lowest effective dose to maintain thyroid hormone levels at the upper end of the normal range, balancing maternal and fetal well-being.
If medication is ineffective or not tolerated, thyroidectomy (surgical removal of the thyroid gland) may be considered. This procedure is typically reserved for severe, uncontrolled cases and is ideally performed during the second trimester to minimize risks to mother and baby. Radioactive iodine therapy is not safe during pregnancy as it can harm the fetal thyroid gland.
Potential Risks for Mother and Baby
Unmanaged Graves’ disease during pregnancy poses risks for both mother and baby. For the mother, these include preeclampsia (a serious blood pressure condition) and thyroid storm. Thyroid storm is a rare but severe complication with a sudden, drastic increase in thyroid hormones, leading to high fever, rapid heartbeat, and confusion. Worsening hyperthyroidism can also occur, particularly in the first trimester and postpartum.
For the baby, complications include miscarriage, preterm birth, and low birth weight.
Neonatal Graves’ disease occurs when maternal thyroid-stimulating antibodies (TRAb) cross the placenta, stimulating the baby’s thyroid gland. This can lead to newborn hyperthyroidism, with symptoms like rapid heart rate, poor weight gain, or an enlarged thyroid gland. Though typically transient, it requires close monitoring and treatment after birth.
Fetal goiter or hypothyroidism can develop if maternal antithyroid medications suppress the baby’s thyroid function too much. Healthcare providers monitor fetal development via ultrasound to detect thyroid issues, such as goiter or heart rate changes, to adjust maternal medication dosages.
Post-Pregnancy Considerations
Postpartum, a mother’s Graves’ disease symptoms can worsen or reappear, even if they improved during pregnancy. This necessitates continued monitoring of thyroid hormone levels and medication adjustments. The healthcare team will re-establish optimal thyroid function.
For breastfeeding mothers, certain antithyroid medications are generally safe. MMI is usually preferred over PTU during lactation because MMI passes into breast milk in smaller amounts, and PTU has had liver toxicity concerns. Healthcare providers guide mothers on appropriate medication dosages to ensure infant safety.
Newborns of mothers with Graves’ disease require monitoring for neonatal Graves’ disease, especially if the mother had high levels of thyroid-stimulating antibodies. This ensures prompt diagnosis and treatment. Neonatal Graves’ disease is usually transient, resolving within weeks or months as maternal antibodies clear.