Q: 32 years old female is admitted to ICU with urosepsis. She is also found to be in postpartum thyroiditis. Which should be the first line of treatment besides management for urosepsis?
A) propranolol
B) methimazole
C) propylthiouracil
D) radiation
Answer: A
Direct anti-thyroid management including methimazole, propylthiouracil, and radiation has no value in postpartum thyroiditis, also known as destructive thyroiditis. The synthesis of T4 and T3 is actually decreased in contrast to other hyperthyroid states. Condition is usually self-limiting and requires only symptomatic treatment.
Propranolol is highly plasma protein-bound. This gives the advantage of minimal concentration in breast milk, and is a choice of beta-blocker in postpartum females.
#endocrinology
#Ob-Gyn
#pharmacology
References:
1. Stagnaro-Green A. Postpartum thyroiditis. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):303-16. doi: 10.1016/j.beem.2004.03.008. PMID: 15157842.
2. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21:85.
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