What are the treatment options for Graves' disease when trying to get pregnant?

Question

Hello doctor,

My sister is 32 years. After her second delivery, she got the problem of diffuse toxic goiter what is called Graves' disease. She is on medication for the last six years. She is on Carbimazole. But, it is not effective as when she stopped taking the medicine she suffers again from the symptoms (heart rate and sweating). The doctor advised her to get treatment by radioactive iodide. But she is worried this can lead to infertility. So, the other choice was to do a surgery to remove the thyroid gland. But, she will be on Thyroxine for the whole life. I wonder if this is the only choice she has. And, if this is the case, what is the best for her as she wants to get pregnant and she is breastfeeding now.

Note:

The thyroid gland is diffusely enlarged with increased tracer uptake and homogeneous distribution.
No definite focal lesion seen.
20 minute Tc uptake = 5.2 %.

Thank you and looking forward to hearing from you.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

Graves' disease treatment options are the following.

Medical therapy with drugs that she is already taking. The relapse rate is very high.
Radioiodine therapy which is the safest and easiest with least side effects. It does not cause infertility.
Surgery - as you said she will require lifelong Thyroxine replacement. Surgery is a complex procedure and is not preferred nowadays.

Therefore, radioiodine ablation is the best and easiest treatment.

I hope this helps.

Thank you.