Pregnancy after definitive treatment for G raves’ disease – Does treatment choice influence outcome?

Background Women requiring thyroid hormone replacement after definitive therapy (surgery or radioiodine) for G raves’ disease who later conceive require an early increase in levothyroxine dose and monitoring of thyroid hormone levels throughout pregnancy. In addition, as TSH receptor antibodies ( TRA b) can cross the placenta and affect the fetus, measurement of these antibodies during pregnancy is recommended. Aim To review the management of pregnancies following definitive treatment for G raves’ disease in order to assess the rates of maternal hypothyroidism and TRA b measurement. Materials and Methods Retrospective chart review of women who had undergone definitive treatment for G raves’ disease at a tertiary hospital and subsequently had one or more pregnancies. Results A total of 29 women were identified, each of whom had at least one pregnancy since receiving definitive treatment for G raves’ disease: there were a total of 49 pregnancies (22 in the surgical group and 27 in the radioiodine group). Both groups had high rates of hypothyroidism documented during pregnancy (47 and 50%, respectively). The surgical group was more likely to be euthyroid around the time of conception. Less than half of the women were referred to an endocrinologist or had TRA b measured during pregnancy. Neonatal thyroid function was measured in one‐third of live births. One case of neonatal thyrotoxicosis was identified. Conclusions Adherence to the current A merican T hyroid A ssociation guidelines is poor. Further education of both patients and clinicians is important to ensure that treatment of women during pregnancy after definitive treatment follows the currently available guidelines.