A 28-year-old woman is diagnosed with Graves' disease. She is 8 weeks pregnant. Which management is MOST appropriate for her hyperthyroidism?
- A Propylthiouracil (PTU) in first trimester, then switch to methimazole ✓
- B Methimazole throughout pregnancy
- C Radioiodine ablation
- D Total thyroidectomy immediately
Correct answer: A. Propylthiouracil (PTU) in first trimester, then switch to methimazole
Explanation
PTU is preferred in the first trimester because methimazole is associated with aplasia cutis and choanal atresia (embryopathy). However, PTU carries higher risk of severe hepatotoxicity with prolonged use, so guidelines recommend switching to methimazole after the first trimester. Radioiodine is absolutely contraindicated in pregnancy. Surgery (thyroidectomy) is reserved for cases with drug allergy or uncontrolled hyperthyroidism, preferably in the second trimester.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.