Graves’ disease is an autoimmune disease. It leads to overactivity of the thyroid gland, hyperthyroidism. They thyroid organ is located at the front of the neck above the collar-bone. It releases  the hormones thyroxine (T4) and triiodothyronine (T3), which controls body metabolism. Thyroid hormone levels are controlled by the pituitary gland. This gland makes thyroid stimulating hormone (TSH), which triggers the thyroid to make thyroid hormone.

In Graves’ disease , the immune system makes antibodies that act like TSH and as a result causes the body to make more thyroid hormone than the body needs. This causes  body functions such as heart disease to  speed  up. Graves’ disease is the most common cause hyperthyroidism.

Who is at risk ?

Anyone can get  Graves’ disease however your risk is increased if you

• have a family history of Graves’ disease
• are younger than 40 years old
• are a woman
• have other autoimmune diseases like type 1 diabetes, rheumatoid arthritis or lupus
• are pregnant or recently had a baby
• smoke
• are emotionally or physically stressed

What are the symptoms of Graves’ disease ?

Most people with Graves’ disease have symptoms of overactive thyroid such as

• enlarged thyroid (goiter)
• rapid heart beat
• weigh loss without dieting
• heat intolerance
• hand tremors
• restlessness and difficulty sleeping
• fatigue and weak muscles
• light menstrual flow or less frequent periods
• difficulty getting pregnant
• frequent bowel movement

You may also encounter problem such

• eyes changes such as bulging eyeballs, eye irritation and tearing
• reddening and thickening of the skin

What is the effect of Graves’ disease on my pregnancy and baby ?

You can get pregnant if you’re being treated for Graves’s disease. However it is essential to plan the pregnancy. The disease must be well-managed before getting pregnant. Otherwise it increases your risk  for the  following complications.

• preeclampsia
• placental abruption
• preterm labor
• miscarriage
• heart failure

Your baby may also be at risk of

• low birth weight
• thyroid problems
• preterm birth
• stillbirth

If you have Graves’ disease and planning on getting pregnant, talk to your doctor first and let him know all the medication you’re taking. You may have to wait for 6 months before getting pregnant if you are on treatment with radioactive iodine (RAI).

How is Graves’ disease diagnosed ?

If you have symptoms that indicate that you have this condition, doctors will run  more tests to confirm. These include

• thyroid function test
• radioactive iodine uptake
• antibody test

This condition can be hard to diagnosed during pregnancy because most of the symptoms are similar to pregnancy symptoms. Doctors  cannot use radioactive iodine uptake test during pregnancy.

How is Graves’ disease managed during pregnancy ?

If you have this condition , you will need to see both an OB/GYN and an endocrinologist during pregnancy.  Let your doctor known if you’ve  had radioactive iodine (RAI) or surgery to treat Graves’ disease in the past and become pregnant. You will be monitored for thyroid related problems that may occur later in pregnancy.

Your baby will also be watched for thyroid problems later in life. You need to plan your pregnancy if you have this condition.

Pregnancy causes hormonal changes which can affect the thyroid. For women with this  disease , symptoms usually worsen in the first trimester and then improve for the rest of the pregnancy. Symptoms usually worsen again after delivery. As a result, the treatment  needs for pregnant women with Graves’ disease usually change  and an experienced  doctor is required to manage them during and after pregnancy.

Your hormone level with be checked regularly by the doctor. If you need medication, the doctor usually prescribes  Propylthiouracil PTU in the  first trimester and Methimazole MMI for the remaining pregnancy. Pregnant women cannot take RAI. Beta blockers are sometimes prescribed for short term during the first few weeks of pregnancy  to  relieve symptoms.

NOTE

Most women who are using  antithyroid medications   breastfeed their babies. Only low amounts of this medication are able to cross into breast milk. However you need to discuss with your doctor the benefits of breastfeeding in addition to any associated risk. This will help you decide.