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Table 3. Advantages and Disadvantages of Treatments for
Preconception Graves' Disease
Graves' disease
treatment option
Advantages related to
pregnancy planning
Disadvantages related to
pregnancy planning
ATDs continued
in pregnancy
• Treatment is easy to take,
discontinue or modify, and
generally inexpensive
• Usually the quickest option
to achieve euthyroidism
(achievable in majority of cases
within 1–2 months)
• Very low risk of permanent
hypothyroidism
• Relatively rapid decrease
of TRAb and/or TSI
concentrations
• Risk of congenital anomalies:
+3% (PTU), +5% (MMl)
• Overtreatment associated
with fetal and neonatal
hypothyroidism
• Requires additional fetal
ultrasounds during pregnancy
• Risk of post-partum relapse
(if stopped during pregnancy)
ATDs stopped
upon pregnancy
(Figure 5)
• Discontinuation can be
considered if there is a low risk of
relapse (>6 months of treatment
with ATD, normal TSH
requiring <10 mg methimazole
or <200 mg PTU per day, and
TRAb concentrations <3×
upper limit).
• Risk of early pregnancy and
post-partum relapse
I-131 therapy • Non-invasive and definitive
treatment option
• Oral administration
• Decreased goiter size usually
seen
• Pregnancy contraindicated for
at least 6 months
• TRAb/TSI concentrations
may increase transiently
over the course of 1–3
years following I-131
administration, which may
increase the risk of fetal and
neonatal hyperthyroidism
• Permanent maternal
hypothyroidism is likely
• Contraindicated in active
moderate/severe thyroid eye
disease
• More than one dose may be
needed
Total
thyroidectomy
• Definitive treatment option
• Euthyroidism usually easily
achievable with thyroid
hormone replacement within
1–2 months
• Serum TRAb/TSI
concentrations fall relatively
quickly
• Alleviates symptomatic goiter,
if present
• Permanent hypothyroidism is
guaranteed, requiring lifelong
thyroid hormone replacement
• Surgical risks, including
recurrent laryngeal nerve injury
(temporary ~7%, permanent
<1 %) and hypoparathyroidism
(up to 6% permanent)
• Recovery period
