Correct!
4. 1 and 3
Treatment of gestational transient thyrotoxicosis is similar to thyrotoxicosis in non-pregnant patients except that radioactive iodine should never be given to a pregnant patient since it crosses the placenta and will also ablate the fetus’ thyroid (4,5). Propylthiouracil (PTU) or methimazole should be given to decrease synthesis of T4, beta blockers to control sympathetic overload and dexamethasone to decrease peripheral conversion from T4 to T3.
Gestational transient thyrotoxicosis is caused by stimulatory action of hCG on the thyroid receptor (4,5). It is clinically similar to Graves’ disease although is typically less severe in pregnant women than Graves’ and is considered less harmful to mother and fetus than an autoimmune cause of hyperthyroidism. The two disorders are distinguished by the presence or absence of thyroid stimulating immunoglobulin.
Our patient was evaluated by hepatology who thought her elevated transaminases and bilirubin were likely the result of her thyrotoxicosis. She was treated with PTU, propranolol and dexamethasone. Her free T4 gradually trended down over the course of 4 days and she was transitioned to the antepartum floor. PTU was stopped on the day of discharge. The patient will be followed as an outpatient for tapering of her propranolol and repeat TSI. She will also follow up in high-risk pregnancy clinic.
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