A 29-year-old woman is diagnosed with Graves' disease. She is 10 weeks pregnant. The treatment of choice at this stage of gestation is:

• A Methimazole throughout pregnancy
• B Radioiodine therapy
• C Total thyroidectomy immediately
• D Propylthiouracil (PTU) in first trimester, switch to methimazole after first trimester ✓

Explanation

Current guidelines (ATA 2017) recommend PTU during the first trimester because methimazole is teratogenic (aplasia cutis, choanal atresia). After the first trimester, PTU carries a hepatotoxicity risk, so switching to methimazole is preferred. Radioiodine is absolutely contraindicated in pregnancy as it ablates the fetal thyroid. Surgery is reserved for patients who cannot tolerate antithyroid drugs and is best performed in the second trimester if necessary.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.