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How is Graves' disease managed during pregnancy?
During pregnancy, you will need to see both your OB/GYN and an endocrinologist (en-doh-krih-NOL-uh-jist), a doctor who treats people with hormone problems. If you have had radioactive iodine (RAI) or surgery to treat Graves' disease in the past and become pregnant, tell your doctor. Your baby will need to be watched for thyroid-related problems that can occur later in the pregnancy. It is best to plan pregnancy so that Graves' disease is treated prior to conception.
Pregnancy may cause changes in hormones that affect the thyroid, and thyroid problems can affect a growing baby. For some women with Graves' disease, symptoms worsen in the first trimester, and then improve for the rest of the pregnancy. Symptoms often worsen again after delivery. For these reasons, the treatment needs of pregnant women with Graves' disease often change, and an experienced doctor is needed to manage your treatment during and after pregnancy.
Your doctor will check your thyroid hormone levels regularly. If antithyroid medicine is needed, PTU is usually prescribed in the first trimester, and MMI for the rest of the pregnancy. Thyroid surgery is rarely an option for pregnant women. And pregnant women cannot take RAI. Beta-blockers are sometimes prescribed for short-term use during the first few weeks of pregnancy to relieve symptoms.