Dear Sir- What one would do with a 20 years old lady with a recently diagnosed graves disease who would like to get married next week. Her partner refused to delay the wedding and will not accept her to be on contraception. What would be the optimum management. Should we operate on her. Would it be better to do total or subtotal thyroidectomy. Is thyroid replacement therapy safe in pregnancy.
Dr Tarek Elatrozy, Gharbia, Egypt
Thyroid replacement is certainly perfectly safe in pregancy. I hesitate to say what is optimum management, not knowing all about the patient. However it is common to carry patients thru pregnancy on antithyroid drugs, with caution not to overdose the antithyroid drug. If there is difficulty with medical management, it is also considered safe to prepare the patient with antithyroid drugs, and operate in the mid trimester. Usually the operation is a subtotal thyroidectomy, but some people prefer a more complete thyroidectomy if the surgeon is skilled and has a low risk of parathyroid or nerve damage in practice. Does this provide what you need?
L De Groot,MD