[Current problems in the treatment of Graves' disease in pregnancy and in lactation].
In Graves' patients complicated by pregnancy, both maternal and fetal problems related to the disease can be reduced or avoided by controlling hyperthyroidism. However, optimal treatment for mothers may exert detrimental effects on fetuses. Methimazole may cause "methimazole embryopathy". Antithyroid drug doses that maintain mothers in euthyroid status are sometimes excessive fetuses. Furthermore, successful treatment with surgery or radioiodine occasionally may result in fetal hyperthyroidism due to TSH receptor antibody(TRAb). There are approaches to manage these problems. Propylthiouracil is chosen in treating Graves' disease in early pregnancy. In later pregnancy, maternal free thyroxine is maintained near or somewhat above normal. Ablative therapy is not recommended in women whose TRAb levels are extremely high from the standpoint of fetal thyroid state.
Momotani
Naoko
N
Division of Endocrinology, Tokyo Health Service Association.
D013956:Antithyroid Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001323:Autoantibodies; D000013:Congenital Abnormalities / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005315:Fetal Diseases / Q000209:etiology / Q000517:prevention & control; D006111:Graves Disease / Q000150:complications / Q000628:therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000517:prevention & control; D007037:Hypothyroidism / Q000209:etiology / Q000517:prevention & control; D018828:Immunoglobulins, Thyroid-Stimulating; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology*; D008431:Maternal-Fetal Exchange; D008713:Methimazole / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D008895:Milk, Human / Q000378:metabolism*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011264:Pregnancy Trimesters; D011441:Propylthiouracil / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
D013956:Antithyroid Agents; D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; C094372:thyrotropin-binding inhibitory immunoglobulin; D008713:Methimazole; D011441:Propylthiouracil