MON-430 - Thyroid Eye Disease in Pregnancy: a retrospective case series from a UK maternal medicine centre

Background: Graves Disease (GD) is the most common cause of hyperthyroidism in women of reproductive age. Thyroid Eye Disease (TED) is the main extrathyroidal manifestation of GD, however, data on TED and clinical outcomes during pregnancy remain limited.

Aims: To investigate the incidence, prevalence, course, management, and outcomes of TED in pregnancy based on European Group on Graves’ Orbitopathy (EUGOGO) 2021 Guidelines.

Methods: A retrospective study of pregnant patients with GD managed at a maternal medicine centre between January 2022 until June 2025. Data collected included demographics, thyroid status and TSH receptor antibody (TRAb) titres, smoking status, TED activity (Clinical Activity Score CAS) , severity and management.

Results: Among 51 pregnant women with GD, 7 (13.7%) (age range 25-39 years) had TED diagnosis (6 had pre-existing TED). 2 were ex-smokers and 1 current smoker. 1 new case of mild TED developed in pregnancy managed conservatively. Thyroid status was erratic in 1 patient and TRAb titres for all patients checked every trimester (when possible) ranged from 0.70- 30.00 unit/l (normal reference range < 0.40 unit/l ). For the 6 patients with pre-existing TED, 5 remained inactive and mild. One (smoker with poor medication adherence) progressed into active TED with CAS 3 moderate- severe in the first trimester and was commenced on a 12 week intravenous methylprednisolone (IVMP) in accordance with EUGOGO guidelines. However, after the third dose, IVMP had to be discontinued due to destabilising effect on her mood and behaviour. Bilateral orbital steroid injections in the third trimester was substituted and the TED became quiescent with CAS score 1. Postpartum, no women experienced worsening of TED , and 1 underwent unilateral eyelid retraction correction surgery.

Conclusion: The development or progression of TED associated with GD during pregnancy is uncommon. Patients with multiple risk factors may experience clinically significant disease activity requiring intervention. Management should be individualised within a multidisciplinary setting, balancing maternal benefit and fetal safety. Pregnancy does not appear to independently worsen TED outcomes in most cases.

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