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

  • I hate Graves Disease

    July 26, 2016, 4:25 p.m.

    Thank you for your advise, I have asked multiple times, gone to several doctors and due to my age 40 they...

  • I hate Graves Disease

    July 26, 2016, 9:58 a.m.

    Sandy40 I am now considering extreme radical measures to deal with these hormones but I will give...

  • I hate Graves Disease

    July 26, 2016, 4:35 a.m.

    Sandy40, just my opinion, but if I had all those problems, thyroid would be gone! Post surgical...

  • I hate Graves Disease

    July 25, 2016, 11:28 p.m.

    Thank you Snelsen for your help and for sharing your journey with graves, well I know people from work that...

  • I hate Graves Disease

    July 25, 2016, 10:03 p.m.

    Sandy, I just logged in…was dealing with all of the when AzGravesGuy was active. So a big hello to him!...

  • I hate Graves Disease

    July 25, 2016, 6:13 p.m.

    Thank you all for your help, I have been told I am in between Hashimotos and Graves while I am taking...

  • I hate Graves Disease

    July 25, 2016, 2:19 p.m.

    AZGravesGuy is right. Not a lot of post thyroidectomy people on the boards because they have moved on with...

  • I hate Graves Disease

    July 25, 2016, 1:24 p.m.

    Hi Sandy, I hated my Graves' Disease too. Almost a decade lost to the physical and mental chaos it brought....

  • I hate Graves Disease

    July 25, 2016, 9:11 a.m.

    Hello and welcome - we have a number of regular posters here who have chosen surgery as their treatment...

  • I hate Graves Disease

    July 25, 2016, 1:14 a.m.

    Hi, I was diagnosed in 2006- 2007 with Graves Disease, it has been up and down for me since then, however had...

  • On Week 12 and very discouraged

    July 20, 2016, 1:22 p.m.

    Hopefully, your doctor is looking at Free T4 and T3 in making dosing decisions. TSH can remain suppressed for...

  • 3 year old with graves

    July 20, 2016, 1:18 p.m.

    Liz1967 Just one study. Methimazole is not a totally innocuous drug. Agranulocytosis is a bone marrow...

  • Iodine questions

    July 19, 2016, 11:14 p.m.

    When I was first diagnosed with Graves', a well-meaning relative suggested that I take an iodine supplement....

  • Iodine questions

    July 19, 2016, 12:35 p.m.

    Hi and welcome to the forum - you'll find lots of help and good information here. Your question caught my...

  • Iodine questions

    July 19, 2016, 10:47 a.m.

    Hello and welcome, I myself have not been diagnosed with hyperthyroidism. However when tested my thyroid...

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

GDATF on Facebook

Support the GDATF and become a member today!

© 2016 Graves' Disease & Thyroid Foundation