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Recommendations Table 16. Monitoring Graves' Disease in
Pregnancy
Strength
*
Level
#
All pregnant women with a history of Graves' disease should
have serum TSH, FT4, and TRAb and/or TSI measured in
the first trimester.
Good Practice Statement
For women with a history of Graves' disease who are not
taking ATDs
a
and who have TRAb and/or TSI measured in
the first trimester:
A. If the TRAb and/or TSI concentration is >3 fold the
upper limit of normal, TRAb and/or TSI measurements
should be repeated at 18–22 and 30–34 weeks along
with monitoring for signs of fetal hyperthyroidism (see
neonatal/fetal hyperthyroidism section).
B. If the TRAb and/or TSI concentration at any time during
pregnancy is <3 times the upper limit of normal and
mother remains euthyroid, TRAb and/or TSI follow-up
measurements and fetal hyperthyroidism monitoring
should be stopped.
Strong Moderate
Euthyroid women with a history of Graves' disease without
prior definitive treatment and who have been in remission for
>1 year should be monitored with thyroid function testing
each trimester (Table 1), followed by maternal thyroid testing
at 4–6 weeks and 4–6 months post-partum.
Good Practice Statement
a
All women using ATDs require fetal thyroid ultrasound monitoring.
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
