MANAGEMENT
OF HYPERTHYROIDISM (HT) IN WOMEN PLANNING / WILLING PREGNANCY
Management
depends on patient’s preference, disease severity, and the timescale for
conception. Pregnancy should be avoided until HT is adequately controlled and
euthyroidism reached. The following issues should be discussed with the
patient:
(I)
REGARDING MEDICAL MANAGEMENT (antithyroid drugs [ATD])
The
potential adverse effects of antithyroid drugs (ATD) on the fetus (birth
defects): Methimazole (MMI) administration during the first trimester is associated
with a relatively high risk of birth defects (2-4 %, some of them severe). Propylthiouracil
(PTU) use in early pregnancy may also result in birth defects, but at a much
lower rate. For this reason, PTU is recommended to treat hyperthyroidism during
the first trimester of pregnancy and then switch to MMI for the rest of
pregnancy (often after 16 weeks of pregnancy). As is the case with all
medications during pregnancy, dose of ATD should be limited to the lowest
effective levels, especially during the first trimester
(II)
REGARGING RADIOIODINE ABLATION THERAPY (RIA, rarely used in Europe, more
popular in the US)
Pregnancy
should be delayed for 6 months post-radioiodine therapy.
(III)
REGARDING SURGERY
Surgery may
be required in the case of contraindications, poor compliance from the part of
the patient, rejection of ATD / RIA, presence of suspicious for malignancy
thyroid nodules etc. Euthyroidism should be achieved and confirmed prior to
conception. The main advantage of surgery is the immediate / permanent cure of
the disease. Ideally, thyroidectomy in patients with hyperthyroidism should be
performed by high-volume, experienced endocrine surgeons.
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