13
Î Cordocentesis should be used in rare circumstances and performed
in an appropriate setting. It may occasionally be of use when fetal
goiter is detected in women taking antithyroid drugs to help determine
whether the fetus is hyperthyroid or hypothyroid. (W-L)
Î If ATD therapy is given for hyperthyroidism caused by autonomous
nodules, the fetus should be carefully monitored for goiter and signs
of hypothyroidism during the 2nd half of pregnancy. A low dose of
ATD should be administered with the goal of maternal FT4 or TT4
concentration at or moderately above the reference range. (S-L)
Table 1. Advantages and Disadvantages of Therapeutic
Options for Women with Graves' Disease Seeking
Future Pregnancy
Therapy Advantages Disadvantages
Antithyroid drugs • Effective treatment to
euthyroid state within 1–2
months
• Often induces gradual
remission of autoimmunity
(decreasing antibody titers)
• Easily discontinued or
modified
• Treatment easy to take
• Relatively inexpensive
• Medication adverse effects
(mild 5–8 %; severe 0.2 %)
• Birth defects associated with
use during pregnancy (MMI
3–4%; PTU 2–3% though
less severe)
• Relapse after drug withdrawal
likely in 50–70%
Radioactive
Iodine
• Easy oral administration
• Reduction in goiter size
• Future relapse of
hyperthyroidism very rare
• Repeat therapy at times
necessary
• Rising antibody titers
following treatment may
contribute to worsening
orbitopathy or fetal risk
• Lifelong need of LT4 therapy
following ablation
yroidectomy • Definitive therapy of
hyperthyroidism
• Stable euthyroid state easily
achieved on replacement LT4
therapy
• Post surgery, gradual
remission of autoimmunity
occurs
• Goiter disappears
• Life-long need for LT4
supplementation
• Surgical complications occur
in 2%–5%
• Healing and recovery from
surgery
• Permanent neck scar
