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* Hyperthyroidisn during Pregnancy
 #854443  
  kruno - 09/13/18 09:50
 
  USMLE CLINIC

During pregnancy the total T3 and T4 levels increase due to increased thyroid hormone production, but the free T3 and T4 levels remain within normal limits.

Just as in non-pregnant patients, hyperthyroidism is screened for by measuring the TSH level (in which case it will be suppressed), and confirmed with the finding of elevated levels of free T4 or T3. However, during pregnancy, trimester specific reference ranges must be used.

Due to teratogenicity, methimazole should not be given during the 1st trimester.
If a thionamide is required, then propylthiouracil should be given.
In the second trimester, however, methimazole is preferred.

If and when possible, definitive therapy with RAI or surgery should be offered 6 months prior to conception in order to avoid the need for thionamides during pregnancy.

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