Management of a pregnant patient with Graves' disease complicated by thionamide-induced neutropenia in the first trimester

A 31-year-old woman presented with neutropenia due to thionamide drug thera py for Graves' disease. She also reported 8 weeks of amenorrhoea and had a positive pregnancy test. Her drug therapy was discontinued and her neutrope nia resolved uneventfully. The hyperthyroidism recurred a week later. After consideration of all treatment options, it was decided to observe until 14 weeks when an elective thyroidectomy was planned. Mother and fetus were mo nitored closely and both tolerated moderate hyperthyroidism well. At 14 wee ks the patient underwent a total thyroidectomy after rendering her euthyroi d with a short course of sodium ipodate, Labour was induced at 41 weeks. De livery was complicated by fetal distress and precipitated a forceps deliver y. A 3250 g male infant was born with poor Apgar score and required 2 h of ventilation. At 1 year, the child had reached all developmental milestones at appropriate times. Both mother and fetus may tolerate moderate thyrotoxicosis well in early pr egnancy, an alternative that should be considered when thionamide drug ther apy is contraindicated.