**6.5 Treatment of Graves' Disease during pregnancy**

Pregnancy is a hyper vascular state so, clinical signs of thyrotoxicosis and normal pregnancy remarkably overlap. Moreover, estrogen induces high serum levels of thyroid hormones make the diagnosis difficult. Graves' Disease affects 0.1–0.2% of pregnancy and carries a considerable risk to mother and new born if not controlled adequately [62]. All ATDs are teratogenic and having risk of birth defects in new born [63]. During pregnancy ATDs should be used in lowest dose to main thyroid hormone levels in upper normal range and monitoring of thyroid function should be done monthly. As pregnancy is a state of immune tolerance so in about 50% of patients ATDs can be discontinued after first trimester [62]. Breast feeding is considered safe during ATDs treatment. ATA recommends measurement

of TRAb at diagnosis, then at 18–20 weeks of pregnancy, if elevated then repeat at 30–34 weeks to guide decision regarding fetal monitoring.
