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Old 10-17-2011
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ObGyn Treatment of hyperthyroidism during pregnancy

A 31-year-old pregnant woman at 28 weeks’ gestation comes to the office for follow-up. On her previous visit, you had noted some weight loss despite a normal appetite. She also had a goiter and a new tremor. Laboratory studies show increased triiodothyronine and thyroxine levels, decreased thyroid-stimulating hormone levels, and the presence of thyroid-stimulating antibodies. Which of the following is the most appropriate treatment at this time?

A. Methimazole
B. Propranolol
C. Propylthiouracil
D. Propylthiouracil and levothyroxine
E. Radioactive iodine
F. Subtotal thyroidectomy
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Old 10-18-2011
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ans C. propylthiouracil . its safer during preg. subtotal thyroidectomy oly if med treat fails , n its done at 2nd trimestr
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Old 10-18-2011
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C. Propylthiouracil
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Old 10-18-2011
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propylthiouracil safest treatment of hyperthyriodism in pregnancy.
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Correct Answer

The correct answer is C. The patient has Graves disease. Hyperthyroidism during pregnancy is associated with Graves disease (most common cause), toxic multinodular goiter, choriocarcinoma, hydatidiform mole, ovarian teratoma, and iatrogenic thyrotoxicosis. Symptoms may include weight loss, tachycardia, exophthalmos, pretibial myxedema, generalized weakness, and tremor. Laboratory findings include an elevated triiodothyronine, thyroxine, and low sensitive thyroid-stimulating hormone. Untreated hyperthyroidism in pregnant women is associated with an increased incidence of neonatal thyrotoxicosis, spontaneous abortion, low birth weight (premature delivery), preeclampsia, and congestive heart failure. Treatment depends on the situation. Although both drugs cross the placenta, propylthiouracil is preferred over methimazole because it does not cross the placenta as easily as methimazole does and is thus the drug of choice. Side effects of these medications include rash, urticaria, arthralgias, and agranulocytosis, which may predispose to maternal infection.
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