Graves' disease and thyroid orbitopathy in pregnancy, narrative literature review
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Thyroid orbitopathy
Graves' disease
birth defects

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Lucero Pantoja, O. D., & Gómez Giraldo, C. M. (2023). Graves’ disease and thyroid orbitopathy in pregnancy, narrative literature review. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 10(2).


Background: Thyroid orbitopathy is a common manifestation of Graves' disease. In pregnancy, uncontrolled Graves' disease represents a challenge for treatment due of the risks it can cause to the mother and fetus.

Purpose: Updated review of Graves' disease and thyroid orbitopathy in pregnancy.

Methodology: Searching in the databases: PubMed, LILACS and Scielo, including literature published up to 2022, both in English and Spanish.

Discussion: Graves' disease affects up to 0.2% of pregnancies. Any serum TSH value below the limit of normality should be evaluated along with serum values of total T4 (TT4) or free T4 and anti-TSH receptor antibodies (TRAbs). PTU is the first-line therapy in the first 12 weeks of pregnancy. OT activity should be assessed with the clinical activity score (CAS) and severity with the EUGOGO classification. Mild cases require local management, while severe cases will require intravenous corticosteroid management. There is a risk of congenital defects with the use of ATD, being higher for MMI versus PTU.

Compared to nondisease controls, adjusted risk ratio (RR) for congenital anomalies was increased for CMZ/MMI (RR, 1.28; 95% CI, 1.06-1.54) and PTU (RR, 1.16; 95% CI, 1.08-1.25). The risk of CMZ/MMI was higher compared to PTU (RR, 1.20; 95% CI, 1.01-1.43).

Conclusion: Early diagnosis and treatment prevents catastrophic outcomes and reduces maternal and fetal morbidity and mortality.
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