Graves disease in pregnancy is listed with a clinical intervention of which procedure?

• A. Radioactive iodine therapy
• B. Methimazole
• C. Thyroidectomy
• D. Levothyroxine

Answer: (C)

Graves disease during pregnancy is managed by balancing control of the mother's hyperthyroidism with fetal safety. The fetus is sensitive to thyroid disruption, so treatments that affect the fetal thyroid are avoided when possible.

Radioactive iodine therapy is not used in pregnancy because it crosses the placenta and destroys fetal thyroid tissue. Levothyroxine is for hypothyroidism, not hyperthyroidism, so it doesn’t treat Graves disease. Antithyroid drugs like methimazole are used to manage hyperthyroidism, but they are medications rather than procedures and carry potential teratogenic risks; they are typically used during pregnancy, with a nuanced approach to timing and selection, rather than as a definitive intervention.

When medical therapy is insufficient, not tolerated, or there are other compelling reasons (such as a large goiter causing compression or a need for rapid, definitive control), thyroidectomy becomes a considered option. Performed in the second trimester to reduce risks to the fetus and mother, surgical removal of the thyroid provides definitive treatment for maternal thyrotoxicosis while avoiding the exposure of the fetus to antithyroid drugs and to radioactive iodine.

Thus, thyroidectomy stands out as a definitive procedural option for Graves disease in pregnancy when definitive management is needed.