Problems of pregnancy planning and gestation in patients with diffuse toxic goiter after radiotherapy

Diffuse toxic goiter (DTG) is the most common cause of thyrotoxicosis during pregnancy, which is associated with a high risk of obstetric and perinatal complications. Self-induced abortion, preeclampsia and premature birth are more common in pregnant women with poorly compensated DTG, and thyrotoxic crisis is the main cause of maternal mortality. The drug of choice for the treatment of DTG during pregnancy is propylthiouracil, and from the second trimester and during lactation, thiamazole. Radiotherapy is one of the most effective, safe and frequently used methods of treatment for DTG, but only in non-pregnant women. Metabolites of 131I freely penetrate the placenta and there is a risk of destruction of the thyroid gland of the fetus. The use of radiotherapy in women of childbearing age is possible only after assessing the level of chorionic gonadotropin 72 hours before the start of such treatment, and pregnancy planning is possible only after achieving persistent euthyroidism, and not earlier than 6 months after radiotherapy. Deviation from the established recommendations can lead to adverse outcomes, which is suggested in our clinical observation.