Grave's Disease: A Case Study

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Grave’s disease is uncommon in pregnancy. It occurs in 0.5 to 3.0% of pregnancies. Grave’s disease is an autoimmune disease that causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism). Common signs and symptoms of hyperthyroidism are nervousness, tachycardia, tremor, sweating, dyspnea, weight loss, goiter, and ophthalmopathy (Alamdari et al., 2013, p. 1-2). Poorly treated or untreated hyperthyroidism during pregnancy may cause preeclampsia, preterm delivery, intrauterine growth restriction, low birth weight, and miscarriage. Other complications may include congestive heart failure, thyroid storm, and postpartum bleeding. In addition, the fetus of hyperthyroid mother is at risk because the stimulating maternal TRAb passes the placenta and may cause fetal hyperthyroidisms. The fetus will experience …show more content…

Smith, a 32 years old pregnant women, is diagnosed with Grave’s disease in her first trimester. According to Alamdari et al. (2013), Bothmethimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy. However, Mrs. Smith should be started on PTU because it is recommended as the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy. Methimazole (MMI) should be avoided during the first trimester of pregnancy because MMI is associated with congenital abnormalities in the fetus that occur during the first trimester organogenesis. After the first trimester, Mrs. Smith should switch to MMI because PTU increases the risk of hepatotoxicity in either the mother or the fetus. Therefore, it is recommended that pregnant women on PTU have liver function tests done every 3 to 4 weeks to screen for any potential liver disease or disorder (p. 3-4). In addition, both PTU and MMI can cross the placenta, which can potentially affect fetal thyroid function. Therefore, it is important to prescribe appropriate doses of anti-doses to prevent fetal hypothyroidism with or without goiter (Azizi & Amouzegar, 2011, p.

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