ABSTRACT
The activity of Graves’ disease fluctuates through pregnancy with thyroid stimulating hormone (TSH) receptor antibody patterns generally reflecting the clinical course of the disease. The clinician must be able to differentiate normal physiological changes from true thyroid disease; however, hyperthyroidism and hypothyroidism may first be detected during pregnancy. Euthyroid women with detectable antithyroid antibodies may have slightly higher first trimester serum TSH values, remaining within the normal range, compared to normal pregnant controls. Levothyroxine replaced hypothyroid women should have thyroid function monitored as they become pregnant and again every 4–6 weeks in the first half of pregnancy. Antithyroid drugs (ATD) are the main treatment for Graves’ disease during pregnancy. Propylthiouracil and methimazole have both been used during gestation. ATD therapy may be stopped preconception or during early pregnancy in women with active Graves’ disease who are euthyroid while taking low doses of ATD.
