Pregnancy outcome following radioactive iodine therapy for Graves' disease in women of childbearing age: a systematic review.

Abstract

Objective: Graves' disease (GD) patients treated with radioactive iodine may face health risks from potential radiation exposure, both for themselves and their offspring. This systematic review aims to comprehensively evaluate the association between prior radioactive iodine (RAI) therapy for GD and subsequent pregnancy outcomes in women of childbearing age.

Methods: A search of the bibliographic databases PubMed/MEDLINE and Web of Science was conducted up to December 2024 to identify relevant studies.

Results: The final systematic review included 1055 patients from 5 articles, all of which were retrospective cohort studies. Two studies reported the incidence of miscarriage after RAI treatment of 2.3% (3/130) and 22.2% (6/27). One study indicated that the miscarriage rate in the RAI group was not significantly different from that in the control groups, while the other did not provide a statistical comparison between groups. Two studies reported the incidence of neonatal hyperthyroidism (NH) after RAI therapy of 11.3% (5/44) and 5.5% (8/145). Both studies indicated that high levels of serum TRAb during late pregnancy were significantly associated with NH (P < 0.05). One study reported the incidence of postpartum thyrotoxicosis (PT) after RAI therapy of 2.1%. Compared with surgical treatment and ATD treatment, patients with RAI therapy had a significantly lower incidence of PT (P < 0.05).

Conclusion: Based on the limited evidence from retrospective studies, current data does not demonstrate a statistically significant increase in the risk of miscarriage or postpartum thyrotoxicosis following RAI therapy, compared to ATDs or surgical treatment. Elevated maternal TRAb levels in late pregnancy were strongly associated with neonatal hyperthyroidism. However, the small sample sizes and heterogeneity in study designs preclude definitive conclusions. Further prospective studies are required to establish more comprehensive and reliable conclusions and to evaluate more pregnancy outcomes.