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Old 11-02-2011
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Thyroid Sub acute thyroiditis during pregnancy

Pt with subacute thyroiditis during Pregnancy presenting with hyperthyroidism I have just read should be given PTU .... But normally in subacute thyroiditis we dont give PTU/carbimazole for hyperthyroid just symptomatic treatment with NSAIDS (sometimes steroid) as the disease itself is self limiting. What do you say?
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Old 11-02-2011
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She is pregnant so this time you have another person inside her who you should be worrying about him/her getting hyperthyroidism so you you treat her this time with PTU to keep her euthyroid during her pregnancy.
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Old 11-02-2011
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Subacute Thyroiditis is never treated with antithyroid drugs.
The treatment is only symptomatic with aspirin, prednisone and propanolol regardless if is pregnant or not.
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Old 11-02-2011
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which is right, guys?
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Old 11-02-2011
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here is what i found guys... the question itself (first aid step 2ck qbank) obstetric q7 too is misleading as they did not give answer option for subacute thyroiditis treatment that everyone would have picked. The right answer would have been symptomatic only (NSAIDS, Propan and if needed steroid) which was not an option


Acute (subacute) thyroiditis: Common during pregnancy, this disorder usually produces a tender goiter during or after a respiratory infection. Transient, symptomatic hyperthyroidism with elevated T4 can occur, often resulting in misdiagnosis as Graves' disease. Usually, treatment is unnecessary.

source http://www.merckmanuals.com/professi....html#v1072690
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Old 11-02-2011
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Yup actually first aid said that the ttt of choice is PTU i did also notice that they didn't give a choice of conservative management. so what did you guys decide on ?
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Old 11-16-2011
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From:
Diagnosis and Management of Thyroid Disease in Pregnancy
Obstet Gynecol Clin N Am 37 (2010) 173–193

"The hyperthyroid phase of thyroiditis can be differentiated from Graves disease by the lack of radioiodine uptake during a thyroid scan. The management of thyroiditis hyperthyroidism is supportive, with b-adrenergic blockers for palpitations and tremors and nonsteroidal antiinflammatory agents or corticosteroids in severe cases. Antithyroid medications are generally not needed because the hyperthyroidism is transient. Women with a history of postpartum thyroiditis should be monitored annually for hypothyroidism and treated accordingly."

From:
A case report of subacute thyroiditis during pregnancy: difficulties in differential diagnosis and changes in cytokine levels.
Gynecol Endocrinol - 01-JUN-2011; 27(6): 384-90

"The disease resolved spontaneously without need for prednisone administration but a hypothyroid phase treated with T4 throughout pregnancy occurred. The pregnancy resulted in a healthy full term infant."


Btw...last ATA/AACE Guidelines
HYPERTHYROIDISM AND OTHER CAUSES OF THYROTOXICOSIS: MANAGEMENT GUIDELINES OF THE AMERICAN THYROID ASSOCIATION AND AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS.
Endocr Pract. First published ahead of print May 24, 2011

Grave´s Disease & pregnancy:
- PTU during first trimester
- MMI after that...

Alternatively, rather than switching to MMI at the end of the first trimester, the patient could remain on PTU during the second and third trimesters, and have hepatic enzymes measured every 4 weeks, at the same time that thyroid function is assessed. However, there are no prospective data that show that this type of monitoring is effective in preventing fulminant PTU-related hepatotoxicity.

For more:
Hyperthyroidism in Pictures

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