What is Graves’ Disease?
Graves’ disease is an autoimmune disease. Autoimmune diseases can cause your immune system to attack your own cells instead of foreign bacteria and viruses. In the case of Graves’ disease, this can lead to the overproduction of thyroid hormone, otherwise known as hyperthyroidism. When thyroid hormone levels are elevated our body’s metabolism is sped up and we may experience various symptoms.
Who Does Graves’ Disease Affect?
Graves’ disease usually develops in middle aged adults, between thirty and fifty, and affects women more often than men. Additional factors that have been linked to this diagnosis include: other autoimmune diseases, family history of Graves’ disease, heightened stress, recent pregnancy, history of infection, and smoking.
During pregnancy, it is normal to see an increase in thyroid hormone levels. This may prevent associating this symptom with a proper diagnosis. Learning about other symptoms and notifying your doctor if you experience them can help solve this problem.
Common Signs & Symptoms of Graves’ Disease
- Bulging Eyes (Graves’ ophthalmopathy)
- Weight loss
- Hand or finger fine tremor
- Fast metabolism
- Menstrual cycle irregularities
- Enlarged thyroid
If left untreated, Graves’ disease can lead to osteoporosis, heart problems or problems with pregnancy.
How Does Graves’ Disease Affect Pregnancy?
Graves’ disease affects metabolism which can alter the regularity of women’s menstrual cycles. Irregular menstrual cycles can decrease a woman’s likelihood of conceiving. If not treated appropriately, pregnant women may experience high blood pressure (preeclampsia) and heart failure. This disorder can also lead to placental abruption, miscarriages, premature births, or stillbirths. Additionally, birth defects may arise in the newborn including abnormal heart rate, abnormal birth weight, and complications with the baby’s thyroid.
How Can Pregnant Women Be Treated?
Antithyroid medicine, radioactive iodine (RAI), and surgical removal of thyroid tissue are the three most common treatments for people diagnosed with Graves’ disease. Some of these treatments are not recommended for pregnant patients.
Methimazole (MMI) and propylthiouracil (PTU) are two antithyroid medications both given a Pregnancy Category D rating by the FDA. Category D means that these drugs have shown potential risks to the developing fetus or the pregnant woman, however the benefits of the medication may outweigh these risks and justify its prescription. It is recommended to take PTU during the first trimester and switch to MMI during the second and third trimester to minimize negative effects on the fetus. At the lowest effective dose, both medications are safe to take while breastfeeding.
It is recommended that women who receive RAI wait six to twelve months before becoming pregnant because this treatment may affect fertility. Studies have shown a decrease in AMH (anti-Mullerian hormone), a hormone associated with fertility, in the bloodstream after RAI treatment. More research needs to be done to see how long these effects last and whether they truly connect to fertility. Women who are currently pregnant or breastfeeding should not undergo RAI.
