title: Graves' Disease Pharmacotherapy in Women of Reproductive Age.
abstract: Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists. Controversy regarding appropriate thioamide therapy before, during, and after pregnancy is reviewed. Surgical and radioactive iodine therapy considerations in this patient population are also reviewed. In patients who may find themselves pregnant during therapy or develop Graves' disease during their pregnancy, consideration should be given to the most appropriate treatment course for the mother and fetus. Thioamide therapy should be used with either propylthiouracil or methimazole at appropriate doses that target the upper range of normal to slightly hyperthyroid to avoid creating hypothyroidism in the fetus. Consideration should also be given to the adverse effects of thioamide, such as agranulocytosis and hepatotoxicity, with appropriate patient consultation regarding signs and symptoms. Individuals who wish to breastfeed their infants while taking thioamide should receive the lowest effective dose. Surgery should be reserved for extreme cases and limited to the second trimester, if possible. Radioactive iodine therapy may be used in nonpregnant individuals, with limited harm to future fertility. Radioactive iodine therapy should be withheld in pregnant women and those who are actively breastfeeding. Clinicians should keep abreast of developments in clinical trials and evidence-based recommendations regarding Graves' disease in reproductive-age women for any changes in evidence-based practice.
authors.affiliation: Department of Clinical Pharmacy, West Virginia University School of Pharmacy, Morgantown, West Virginia.|Department of Clinical Pharmacy, Cabell Huntington Hospital, Huntington, West Virginia.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Prunty
authors.affiliation: Department of Clinical Pharmacy, Cabell Huntington Hospital, Huntington, West Virginia.|Department of Pharmacy Practice, Administration, and Research, Marshall University School of Pharmacy, Huntington, West Virginia.
authors.forename: Crystal D
authors.initials: CD
authors.lastname: Heise
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia.
authors.forename: David G
authors.initials: DG
authors.lastname: Chaffin
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000188:drug therapy; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D013854:Thioamides / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D013854:Thioamides
keywords: breastfeeding; endocrinology; pharmacology; pregnancy; thyroid; women's health