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Graves’ Disease and Pregnancy

How common is Graves’ and what are some risks for pregnancy?

Graves’ disease, a common autoimmune condition that causes the thyroid to overproduce thyroid hormone and thereby speed up the body’s metabolism (called hyperthyroidism), can have a negative impact on both fertility and pregnancy.  As such, it is especially important for women who are pursuing pregnancy to receive a prompt diagnosis and effective treatment.

Overall, about 2% of the female population has Graves’ disease and of these, many are diagnosed in pregnancy (1/1,500 pregnant women will get Graves’).  Prior to pregnancy, Graves’ can affect fertility by causing irregular menstrual cycles.   There is also some research that indicates the antibodies (i.e., immune attack cells) circulating in autoimmune women’s bodies reduce both conception and response to fertility treatments.

In pregnancy, Graves’ can lead to miscarriage, premature birth, eclampsia (hypertension of pregnancy), and ‘small for gestational age’ (SGA) babies.  While you may feel overwhelmed and concerned about the health of your growing or planned baby with this diagnosis, try to take a deep breath and find comfort in the fact that that thyroid conditions are extremely common and obstetricians, midwives, endocrinologists and alternative health practitioners deal with them all the time.   Also, you will feel, physically, much better when your thyroid hormones get sorted out and feeling better will help you cope with the sorrow you may have over your diagnosis.

There are several proven-effective treatment options to discuss with an endocrinologist, and as many unproven and unresearched management programs from alternative health providers.  The links below provide additional information of diagnosis and treatment of Graves’ disease:
http://www.mayoclinic.com/health/graves-disease/DS00181
http://www.thyroid.org/wp-content/uploads/patients/brochures/Graves_brochure.pdf
http://emedicine.medscape.com/article/120619-treatment
http://www.thyroid.org/wp-content/uploads/patients/brochures/Thyroid_Dis_Pregnancy_broch.pdf

What are some considerations for planning to become pregnant if I have Graves’ disease?

Before becoming pregnant, you must try to get your thyroid hormones into a normal range and stabilized (it often takes a few months of treatment before everything gets into range).  Generally, endocrinologists try to get control of the overactive thyroid and then keep the TSH (thyroid stimulating hormone level) between 1-2 mIU/L.  Your T3 and T4 levels will also be monitored once you’re pregnant, as pregnancy will independently affect thyroid hormone levels.

And don’t forget your folic acid while you’re planning for pregnancy – you should be on a prenatal vitamin for at least three months before you get pregnant!

Will I still be able to take my medicine while pregnant?

Absolutely.  You should never stop a medication without consulting your provider.  After radioactive iodine or surgical treatment, you will become hypothyroid (i.e., have an underactive gland) and your medication is supplemental thyroid hormone.  If you choose to treat the Graves’ with medication, propylthiouracil, (PTU) is generally the preferred and more widely used option.

What is the likelihood of passing on a thyroid condition to my child(ren)?

If the Graves’ goes unmanaged during pregnancy, there is a risk the baby will be born with hyperthyroidism (this is very rare).  Overall, any family member of a person with autoimmune disease has a higher likelihood of developing the same or another autoimmune disease, so your child does have an increased risk (the exact risk is unclear).  However, while we don’t entirely understand autoimmunity, we do know that genetics alone do not explain its onset and there are likely several environmental factors that play a role.

Is there anything complementary/alternative approach that I can take to help my body adjust to pregnancy while managing my hyperthyroid symptoms, especially if they change while I am pregnant?

Alternative health encompasses a huge array of therapies including Ayurveda, Chinese Medicine, Herbalism, Acupuncture and Homeopathy, to name just a few.  All of these schools offer a variety of treatments for thyroid conditions, though none of these treatments has undergone testing by conventional medical standards or been proved to work (and there’s even less information regarding their use in pregnancy).

Some common treatments include: Bugleweed (Lycopus virginica), Gypsywort (Lycopus europaeus), Lemon balm (Melissa officinalis), Stephania root (Stephania tetranda), and Motherwort (Leonurus cardica).

Questions for your doctor:

  • When can I expect to feel better?
  • Should I have a consultation with a “high risk” obstetrician (called Maternal-Fetal Medicine) if my hormone levels are abnormal in pregnancy?
  • Are there any concerns about breastfeeding with these medications?
  • Should I be screened for other common autoimmune diseases?

References
http://meps.ahrq.gov/mepsweb/data_files/publications/st348/stat348.pdf
http://www.ncbi.nlm.nih.gov/pubmed/11119728
http://haveababy.com/infertility-information/types-of-autoimmune-implantation-dysfunction/
http://www.naturaltherapypages.com.au/article/natural_therapies_for_graves_disease
http://www.thyroid.org/wp-content/uploads/patients/brochures/Thyroid_Dis_Pregnancy_broch.pdf

 

About the Author
Kathi Kuntz, RN, MSN holds a Bachelor’s and a Master’s Degree in Nursing from the University of Pennsylvania. Her specialization is in the healthcare of women and her graduate research thesis was on autoimmune disease in pregnancy. She has over ten years of clinical practice experience. Currently, Kathi is on an adventure living and traveling with her husband and two young sons in Australia.

 

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Comments

  1. I am 26 years old and had a total thyroidectomy one month to date ago. Me and my husband would love to start having children.
    1. Is there a high risk that something will be wrong with my baby or he/she will be harmed?
    2. Am I high risk?
    3. If I am overall healthy will it be hard to get preggers?

    • Katie Cleary says:

      Hi Suzanne, these are great questions for your Ob and I recommend you find one who has experience with fertility and autoimmune, know that can be a tall order but that is my first thought. There are some risks that are higher than in the general population but you have your age going for you, so that will help. Here is another post that talks about other risks in those with Hashi and although you do not have Hashis, the post might be good as I believe some of this may apply since you are now in a hypothyroid state with no thyroid. Correct me if I am wrong on that! Good luck and keep us posted!! We are pulling for you! Take care, Katie

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