Surgery in pregnancy carries more risks than medical
therapy and is complicated by hyperthyroidism. It is
associated with an increased risk of spontaneous
abortion or premature delivery (45). Thyroidectomy in
maternal hyperthyroidism is rarely indicated, and
subtotal thyroidectomy is indicated in patients with major or severe adverse reactions to antithyroid drugs,
and if hyperthyroidism is uncontrolled because of lack of
compliance, high doses of antithyroid drugs are
required to control the disease (46) and large goiter
that may require high doses of antithyroid drugs (ATD).
The optimal timing for surgery is in the second trimester
when organogenesis is complete, the uterus is relatively
resistant to stimulating events, and the rate of
spontaneous miscarriage is reduced.