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THYROID THURSDAY – Pregnancy and Graves’ Disease

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Dr. Raymond Douglas, a thyroid eye disease expert in Los Angeles, invites Dr. Pejman Cohan, a renowned endocrinologist and expert in thyroid diseases, to discuss the role that Graves’ disease can play in expectant mothers’ lives.

I’m dr. raymond douglas i’m an occupy can orbit surgeon here in beverly hills california and today i’m joined by dr. pez man cohan who’s an endocrinologist here in beverly hills and treats patients with graves disease today we’re going to be speaking about pregnancy and graves disease and this is a very hot topic and i look forward to learning a lot about the thyroid

Management during this process but dr. going what what can we begin to to learn about what happens in pregnancy in with patients who have graves disease what are their symptoms and and what can you kind of tell us that they should be looking out for during this process absolutely so a great disease is an autoimmune condition and pregnancy is generally a state of

A down regulated immune system and so in the situation of a woman who has graves disease and then becomes pregnant a lot of times the condition actually gets better because the immune system is not as active and and therefore the the condition of graves disease actually quiets down a little bit now that doesn’t always happen and so women who are pregnant need to

Be monitored extra carefully compared to women who who are not carrying a baby because if the hyperthyroidism is uncontrolled they can have negative consequences not just for the mom but for the fetus as well okay so we really really track patients with graves disease and pregnancy carefully it is a team effort where we’re working with their obstetrician sometimes

Depending on how severe the condition is they may be seeing a high-risk obstetrician not always but sometimes and and we’re monitoring their levels very carefully and eye disease can also happen with graves disease with the inflammation bulging and that also typically gets better during pregnancy many people have to take medication during pregnancy for the graves

Disease including methimazole or ptu is that of any danger for them and for the baby yeah this is this is often a big question of an expectant mom because they want to do everything they can to protect their baby and they don’t want to take anything that could be potentially deleterious to their to their baby so it’s a charged topic and it’s gone through some areas

Of of controversy over the years in general the the feeling is that during the early part of the pregnancy if a woman needs to be on an anti thyroid medication that we generally choose propylthiouracil or ptu as the preferred initial medication and and that’s because there are some really rare case reports of a condition called aplasia cutis where the hair of the

Fetus doesn’t develop in those feed in those pregnancies where the mom was taking tap is all okay so during the first part of pregnancy usually the first trimester we we tend to favor perhaps using ptu or purple value uracil then as the pregnancy continues we can then perhaps change them over to tap as well and the reason behind that is that tap as well may have a

Lower risk of causing liver enzyme abnormalities or we’re putting some pressure on the liver now you know this is this is not a hard and fast rule and endocrinologist have different different opinions but i think the main take-home message is that many times in the woman who has graves disease and becomes pregnant the medication needs to be lowered and so whatever

Medication they’re on they need because the condition is autoimmune and often gets better that medication may need to be reduced and thyroid function tests have to be done to to monitor that and to gauge that okay since the mother has graves disease does that mean that the baby will have graves disease or is there no relation from one to the other because graves

Disease is again an autoimmune problem and there are antibodies that are released in in you know measurable levels in the bloodstream of the mom some of those antibodies can cross over the placenta and now you know get directed against the fetal thyroid and cause the fetus to develop hyperthyroidism and a condition called neonatal hyperthyroidism so we do want to

Check the antibody is usually called thyroid stimulating immunoglobulin generally in the second or third trimester and see if we can find a high level of those antibodies than were specially cautious to refer those pregnant women to a high-risk obstetrician who can really monitor the fetus and these obstetricians have the capability to actually do a sonogram and

Evaluate the fetal thyroid and see whether it’s swollen or enlarged and make decisions about you know adjusting the medication and helping the under chronologiste who is also on the team so a lot of information but i know a very complicated topic and thank you so much for your insights and we can certainly hopefully drop on those a bit more in future segments absolutely

Transcribed from video
THYROID THURSDAY – Pregnancy and Graves' Disease By Raymond Douglas MD PhD