Severe hyperthyroidism in pregnancy

 Q: 27 years old 20 weeks pregnant female never been under clinical care is admitted to ICU with severe hyperthyroidism. All of the following can be parts of management EXCEPT?

A) Thionamides 

B) Beta-blockers 

C) Thyroidectomy

D) Plasmapheresis 

E) Radioiodine

Answer: E

Pregnancy presents special challenges in hyperthyroidism, particularly in an acute situation. One of the objectives of this question is to introduce the readers the use of plasmapheresis (choice D) in an acutely decompensating pregnant female with hyperthyroidism.

Thionamides (choice A) continues to be the mainstay of severe hyperthyroidism in pregnancy. When it comes to B-blockers (choice B), it should be remembered that atenolol is not recommended in pregnant patients, though metoprolol or propranolol can be used. Thyroidectomy (choice C) is reserved for rare cases like females who are not candidates for thionamides treatment.

Radioiodine (choice E) is absolutely contraindicated in pregnancy.

#ob-gyn

#endocrine

References:

1. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2543. 

2. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343. 

3. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315. 

4. Adali E, Yildizhan R, Kolusari A, et al. The use of plasmapheresis for rapid hormonal control in severe hyperthyroidism caused by a partial molar pregnancy. Arch Gynecol Obstet 2009; 279:569. 

5. Stoffer SS, Hamburger JI. Inadvertent 131I therapy for hyperthyroidism in the first trimester of pregnancy. J Nucl Med 1976; 17:146.