The Management of Gravesʼ Disease during Pregnancy

The present article reviews the authorsʼ experience in treating Gravesʼ disease during pregnancy from 1960 to 1979. It is based on the records of 25 women, aged 17 to 40 years, with Gravesʼ thyrotoxicosis. The outcome of pregnancy and the status of mother and child were known in each case.The diagnosis was established principally by means of history, physical examination, and determinations of total and free thyroxine. Six patients were treated medically, 10 surgically (including a 10− to 14-day treatment with Lugolʼs iodine solution preoperatively), and nine with a combination of medical and surgical therapy.In the six medically treated patients, three different types of regimen were used (Table 1). One patient was treated with propranolol postpartum and ablated with | after delivery. Four of the remaining five were delivered of term infants, and the fifth had an uncomplicated premature delivery.The authors prepared the thyrotoxic surgical patients with Lugolʼs iodine solution and repeated the treatment postoperatively (for a brief time) in selected instances. This preparation was followed by bilateral subtotal thyroidectomy, leaving 1–3 gm on each side. Of the five patients who underwent thyroidectomy during the first trimester, two aborted spontaneously 6–7 weeks after the operation, two had premature delivery, and one had term delivery. One of the spontaneous abortions occurred in a patient whose pregnancy was unsuspected at operation. Of the four patients operated on during the second trimester, one had an induced abortion for nonmedical reasons, and three