A 45-year-old woman with known Graves' disease on carbimazole 30 mg/day for 12 months is now euthyroid. She requests definitive therapy before a planned pregnancy in 6 months. Which is the most appropriate recommendation?

• A Continue carbimazole for another 12 months then reassess
• B Total thyroidectomy with post-operative thyroxine before conception ✓
• C Radioactive iodine ablation now, allow 6 months before conception
• D Switch to propylthiouracil for the duration of pregnancy

Explanation

For a patient planning pregnancy in 6 months, total thyroidectomy is preferred over radioactive iodine (RAI) ablation because RAI requires at least 6–12 months of pregnancy avoidance post-treatment and carries risk of transient worsening of TRAb levels that may affect the fetus. Surgery allows rapid achievement of euthyroidism on levothyroxine within weeks. PTU/carbimazole continued into pregnancy is acceptable but does not provide definitive treatment.

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

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Written and medically reviewed by the StethoPrep medical team.