Management of graves disease in pregnancy

1. 4/3/2022
By Dr Mengistu Kassa
Assistant professor of General surgery
Debretabor university , Ethiopia

2.  Human chorionic
gonadotropin(hCG
)
 Sub units (alpha and
beta subunits
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3.  In late first trimester of pregnancy
 May be due to high level of hCG (100,000-
200,000 U/L)
 TSHRAb- to differentiate from early graves
disease
 Treatment : self limiting in most pts
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4.  Truly over active
thyroid gland is
uncommon in
established pregnancy
(2%). Why?
 Fall in thyroid
autoantibody
secretion(TPOAb,TgA
b,and TSHRAbs)
 Effect of thyroid
antibody in the fetus?
 Diagnosis
 TSH below trimister
specific lower limit
 Lower limit of serum
TSH level in
pregnancy(0.06, 0.3
and 0.3 mU/L)
 TSHRAb
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5.  Greater problem that diagnosis
 Antithyroid drug
 Iodine and B- blockers
 Surgery
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6.  Usual method of treatment
 Over treatment is common problem
 Both PTU and metimazol cross the placenta
readily and equally
 Therapeutic antithyroid potency ratio of
methimazole to PTU is around 20:1
 PTU- first trimister
 Methimazole in second and 3rd trimister
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7.  Dander period is b/n 6 to 10 wks of gestation
 Aplesia cutis
 Abdominal wall defect
 Esophageal atresia
 Cardiac defect
 Choanal atresia
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8.  Avoid iodine treatment for more than 2 to 3
wks
 B- blockers:- use safely for short period of time
or at very low dose
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9.  Avoid major surgery in pregnancy if possible.
 In second trimester

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