USMLE Internal Medicine Review 12 10 Treatment of Thyrotoxicosis in Pregnancy

USMLE Internal Medicine Review 12 10 Treatment of Thyrotoxicosis in Pregnancy

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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 12 10 Treatment of Thyrotoxicosis in Pregnancy Below

 

Begin 12 10 Treatment of Thyrotoxicosis in Pregnancy Transcription

Let’s say a few words about thyrotoxicosis and pregnancy.

Why is radioiodine therapy contraindicated in pregnant patients?

  • Radioiodine therapy is contraindicated in pregnant patients because radioiodine crosses the placenta freely and may injure the fetal thyroid.

What is the recommended alternative treatment if thyrotoxic is detected in the first trimester?

  • The pregnant patient in her first trimester can be safety treated with Propylthiouracil.

Is breast feeding allowable while the patient is on Propylthiouracil?

  • Breast feeding is ok because Propylthiouracil is not concentrated in the milk.

And what is the treatment of choice if thyroid disease is detected during the second trimester?

  • Subtotal thyroidectomy.

Thyroid supplementation is essential throughout the rest of the pregnancy. And which treatment option is available throughout the pregnancy?

  • Antithyroid drug therapy, postponing a decision on long term management until after the delivery.

Do antithyroid drugs cross the placenta?

  • Yes, antithyroid drugs should be kept to the minimum therapeutic dose because these agents can affect the function of the fetal thyroid gland.

Student doctor please pause the tape and summarize treatment of thyrotoxicosis in pregnancy. Please include radioiodine therapy, Propylthiouracil, subtotal thyroidectomy, and antithyroid drugs.

  • Radioiodine therapy is contraindicated in pregnant thyrotoxicosis patients because of its propensity to cross the placenta freely and may injure the fetal thyroid. The recommended alternative treatment if thyrotoxicosis is detected in the first trimester is Propylthiouracil. Breast feeding is allowable while the patient is on Propylthiouracil because the drug is not concentrated in the milk. The treatment of choice if thyrotoxicosis is detected in the second trimester is subtotal thyroidectomy. Thyroid supplementation is essential throughout the rest of the pregnancy. Antithyroid drug therapy is available throughout the pregnancy. Pregnant patients can postpone can postpone a decision on long term management until after the delivery.  Antithyroid drugs should be kept to the minimum therapeutic dose however, because these agents can cross the placental barrier and affect the function of the fetal thyroid gland.

A few statements on the course and prognosis of Graves’ disease before we conclude with summaries of a few other forms of thyrotoxicosis. Generally, the course of Graves’ disease is a series of remissions and exacerbations over a long period of time unless the thyroid gland is eliminated through surgery or radioactive iodine therapy. While some patients may remain euthyroid for a long time after treatment, most will develop hypothyroidism. Lifetime follow-up is indicated for all Graves’ disease patients

****END OF TRANSCRIPTION****

 

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