title: Management of Graves' disease during pregnancy in the Poitou-Charentes Region.
abstract: Graves' disease (GD) during pregnancy involves risks for the mother, foetus and neonate.
  
  
  OBJECTIVE
  To compile an inventory of the clinical practices regarding the management of GD during pregnancy in the Poitou-Charentes region of France. This was a retrospective, multicentre study covering the period 2005 to 2012. Ninety-five pregnancies were reviewed: 14 GD diagnosed during pregnancy, 24 GD already treated with synthetic antithyroid drugs (SAT) prior to pregnancy, 25 GD in remission before pregnancy and 32 GD who had undergone thyroidectomy prior to pregnancy. In patients under SAT and/or with TSH receptor antibody levels (TRAb)>3N at the 2nd (T2) and/or 3rd trimester (T3) of pregnancy, a foetal thyroid ultrasound (FTU) was performed in 18/32 cases and neonatal thyroid screening (NTS) in 14/20 cases. One case of foetal hyperthyroidism, two of neonatal hyperthyroidism and three of foetal hypothyroidism (including one neonatal hypothyroidism) were observed. Propylthiouracil was the preferred treatment prescribed, whatever the trimester. A congenital malformation was observed in 4/19 foetuses exposed to carbimazole during the 1st trimester (T1). In operated patients, TSH levels were>2.5mIU/L during T1 in 23/32 cases, while TRAb were not assayed during pregnancy in 12/32 cases. The management of GD during pregnancy could be improved by adjusting SAT therapy during its course, titrating levothyroxine prior to conception and in early pregnancy in thyroidectomised patients, and a more targeted use of FTU during T2 and T3 and of neonatal thyroid screening.
authors.affiliation: Service de diabétologie, endocrinologie et nutrition, Centre Hospitalier Départemental La-Roche-Sur-Yon, Les-Oudairies, 85925 La-Roche-Sur-Yon cedex 9, France. Electronic address: claire.hawken@chd-vendee.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Hawken
authors.affiliation: Service Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Poitiers, 86000 Poitiers, France.
authors.forename: Mélie
authors.initials: M
authors.lastname: Sarreau
authors.affiliation: Centre hospitalier de La Rochelle, 17000 La Rochelle, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bernardin
authors.affiliation: Open Care Endocrinologist, 16000 Angouleme, France.
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Delcourt
authors.affiliation: Open Care Endocrinologist, 16000 Angouleme, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Muller
authors.affiliation: Centre hospitalier de Niort, 79000 Niort, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Lefort
authors.affiliation: Centre Hospitalier Départemental La-Roche-sur-Yon, Les-Oudairies, 85925 La-Roche-Sur-Yon cedex 9, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Pernollet
authors.affiliation: Service Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Poitiers, 86000 Poitiers, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Marechaud
mesh_terms: D000293:Adolescent; D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006111:Graves Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D013960:Thyroid Function Tests; D013965:Thyroidectomy / Q000706:statistics & numerical data; D013974:Thyroxine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D013956:Antithyroid Agents; D013974:Thyroxine
keywords: Antithyroïdien de synthèse; Graves’ disease; Grossesse; Hyperthyroidism; Hyperthyroïdie; Maladie de Basedow; Pregnancy; Synthetic antithyroid drug