Table 5.

Specific Recommendations for Graves' Disease^a

Situation	Management of mother	Management of fetus	Comments
Pregnancy occurs in active GD	Monitor TFTb monthly, and adjust ATD accordingly	Monitor fetal pulse, that should not be tachycardic (>160 bpm)	Mother should continue with ATD
	Assessment of TSHR-Ab titers (3rd trimester) to evaluate if fetus is at risk	If maternal TSHR-Ab titers are elevated, it is recommended to investigate neonatal thyroid function after partum	Fetal tachycardia should respond to ATD
	Reassessment after partum
New diagnosis of GD during gestation	ATD therapy should be started as soon as diagnosis is made
GD relapse during 1st trimester	ATD therapy should be restarted
Gestation after previous ablative therapy (surgery or radioiodine) for GD	Maternal hyperthyroidism is not possible		If fetal tachycardia is noticed in fetus with maternal positive TSHR-Ab, it is advisable to initiate treatment with PTU 100–200 mg/8 h and also continue LT4 supplementation to mother to maintain maternal euthyroidism
	Reassess TSHR-Ab levels at beginning of pregnancy in order to evaluate possibility of fetal or postnatal hyperthyroidism

^aManagement of Graves' disease (GD) in pregnancy requires particular consideration, keeping in mind the consequences of treatment on both mother and fetus. Stimulatory TSHR-Abs may stimulate both thyroids.

^bTFT, thyroid function tests; ATD, antithyroid drugs; PTU, propylthiouracil.