Hold control (command on a Mac) and press the + key as many times as necessary to increase the font size.
Hold control (command on a Mac) and press the - key to reduce the font size. - hide

Graves' Disease and Pregnancy Planning - 2010



Graves’ Disease in Pregnancy Planning

by Giuseppe Barbesino, M.D.

Both hypothyroidism and hyperthyroidism can affect fertility.  Achieving a euthyroid state may in itself restore normal fertility. Doctors typically recommend that all women with raves’ disease become euthyroid before pregnancy.

Thyroid disorders can impair the health of both you and your baby during pregnancy. Therefore, if you already know that you have Graves’ Disease, you should consult with your doctor before trying to conceive.

Some people develop hypothyroidism as a consequence of Graves’ disease treatment with radioactive iodine. If you have hypothyroidism and are taking thyroid hormone, your levels of thyroid hormone and TSH (the pituitary hormone that regulates your thyroid’s function) should be tested before you proceed with a pregnancy. To avoid any damage to the baby’s neurological development early in pregnancy, your daily dose of thyroid hormone should be adjusted to achieve completely normal thyroid function and a TSH level between 0.5 and 2.5 before you conceive.

If you have hyperthyroidism and want to conceive, you and your doctor can discuss several options.  Many physicians advise women to have a definitive cure of hyperthyroidism before becoming pregnant. This can be accomplished with radioactive iodine or surgery. Both of these methods typically result in hypothyroidism, which can then be treated with thyroid hormone. With radioactive iodine, enough thyroid cells are damaged or destroyed so that the thyroid stops producing excessive thyroid hormone. Radioactive iodine is given by mouth in a single visit, but it may take up to six months to complete its effects. Therefore, it is recommended that women wait six months after treatment before they become pregnant. Surgery to remove all or most of the thyroid gland is the quickest way to definitively correct hyperthyroidism. Women can plan on a pregnancy two to three months after surgery. However, surgery is also a more invasive treatment, as it requires general anesthesia and carries a small but concrete risk of complications.

Alternatively, hyperthyroidism can be managed effectively with medications (anti-thyroid drugs). Two anti-thyroid drugs are available in the United States: methimazole (Tapazole) and propylthiouracil (PTU). PTU is nowadays very rarely used in Graves’ disease as it has been linked to several cases of fatal liver disease. If you are taking Tapazole, your physician will probably have you switch to PTU if you are taking Tapazole.  This is because Tapazole has been associated with extremely rare but serious malformations in the fetus when given during the first trimester. Your dosage will be lowered before pregnancy to the minimum amount capable of maintaining your thyroid function in the upper-normal range. Because pregnancy reduces the autoimmune reaction, many women can actually stop their anti-thyroid drugs in the second half of their pregnancy. If not, Tapazole is re-started in the second trimester, when the fetal development is well advanced and the risk of malformations is nil.

Whichever option you choose, it is important that your hyperthyroidism be fully corrected before you become pregnant. That’s because pregnancy with untreated hyperthyroidism is associated with such problems as a higher risk for miscarriage, premature birth, and malformations. These risks clearly outweigh any of the risks posed by the available treatments.

Used with permission of the author:  Dr. Giuseppe Barbesino, Assistant Professor of Medicine, Thyroid Associates, Massachusetts General Hospital

Download as a PDF.

Recent News

Recent Forum Posts

  • Other conditions possibly coexsting with Graves'

    July 22, 2014, 6:14 p.m.

    Hello and welcome! This is one of the better pieces that I've seen on Graves'/Hashi's and related autoimmune...

  • Other conditions possibly coexsting with Graves'

    July 22, 2014, 3:53 p.m.

    Hello fellow Gravesters, I was finally diagnosed with Grave's last year, but believe that I have been dealing...

  • Peripheral neuropathy and leg cramps

    July 22, 2014, 10:51 a.m.

    Hello - I do know of one other patient who experienced peripheral neuropathy at the onset of Graves', but I...

  • Is there always weight gain after TT? RAI?

    July 22, 2014, 10:47 a.m.

    JEH PS Do you guys all have to read your posts over to be sure they make sense? I do. Guess it's part of the...

  • Peripheral neuropathy and leg cramps

    July 22, 2014, 9:33 a.m.

    So there are two symptoms I have been dealing with since even before I was diagnosed with GD. The PN causes...

  • Is there always weight gain after TT? RAI?

    July 22, 2014, 9:20 a.m.

    So I went off all my thyroid meds in 2006 at the recommendation of new endo. Heart rate and BP remained...

  • Loss of appetite after RAI?

    July 22, 2014, 7:08 a.m.

    Hi Michaela, With me it's just the other way around. I had RAI in July 2013, and ever since I haven't seen a...

  • Question about TED surgery

    July 21, 2014, 4:42 p.m.

    Hello - I'm not familiar with that procedure, but hopefully, you will see some other responses. I did find...

  • Question about TED surgery

    July 21, 2014, 12:41 p.m.

    Hi. I was diagnosed with Graves in September 2011 and TED in June 2012. I underwent 10 radiation treatments...

  • Loss of appetite after RAI?

    July 21, 2014, 10:44 a.m.

    Hello - Hopefully, others who have had RAI will chime in here, but I do not recall hearing this as a common...

  • Does weight loss affect dosage?

    July 21, 2014, 10:39 a.m.

    Hello - Weight is a factor in making the initial estimate of thyroid replacement hormone, although a recent...

  • Loss of appetite after RAI?

    July 20, 2014, 12:53 p.m.

    I don't know if this has to do with treating Graves in general, or happens after RAI, but I did RAI slightly...

  • Is there always weight gain after TT? RAI?

    July 19, 2014, 7:06 p.m.

    Hi JEH< Soooo…when we have Graves' all of us begin with an ATD, anti thyroid drug, to decrease our...

  • Is there always weight gain after TT? RAI?

    July 19, 2014, 3:53 p.m.

    Thank you so much Shirley. I thought TT meant thyroid treatment verses radiation or surgery. Opps. Although...

  • Dual Diagnosis

    July 19, 2014, 3:45 p.m.

    I remember hearing all of my life about my paternal grandmother (who was a centenarian when she passed in...

Questions? Problems? Please contact us at info@ngdf.org or 877-643-3123.

GDATF on Facebook

Support the GDATF and become a member today!

© 2014 Graves' Disease & Thyroid Foundation