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Graves Disease Initial Treatment — RACP Adult Medicine MCQ

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ModerateEndocrinologyGraves Disease Initial TreatmentRACP Adult Medicine

A 30-year-old woman with newly diagnosed Graves disease (diffuse goitre, TRAb positive, free T4 55 pmol/L) presents with thyrotoxic symptoms. She is planning pregnancy in 12-18 months. She has no ophthalmopathy. What is the most appropriate initial treatment?

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Correct answer: A — Carbimazole (titration regimen)

Carbimazole (titration or block-and-replace regimen) is first-line for newly diagnosed Graves disease. For women planning pregnancy, a 12-18 month course of carbimazole with the aim of achieving remission before conception is preferred. PTU is preferred in the first trimester of pregnancy (carbimazole is associated with choanal atresia and aplasia cutis). RAI is contraindicated in pregnancy and within 6 months of conception.

Reference: ESA – 2024 – Thyroid Guidelines; ETA 2018 Graves; eTG Endocrine 2024