Graves' Disease — RACP Adult Medicine MCQ

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HardEndocrinology & DiabetesGraves' DiseaseRACP Adult Medicine

A 45-year-old woman presents with palpitations, weight loss, tremor, and heat intolerance. Thyroid function tests show TSH <0.01 mIU/L, free T4 38 pmol/L, and free T3 12 pmol/L. TSH receptor antibodies are positive. She is planning pregnancy within 6 months. What is the most appropriate management?

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Correct answer: B — Propylthiouracil (PTU) titration regimen

For women planning pregnancy, antithyroid drugs are preferred over radioactive iodine (contraindicated in pregnancy/conception within 6 months). PTU is preferred in the first trimester due to the teratogenicity risk of carbimazole/methimazole (aplasia cutis, choanal atresia). PTU should be used in a titration regimen. Carbimazole can be substituted after the first trimester.

Reference: eTG – 2025 – Endocrinology; ATA – 2017 – Hyperthyroidism Guidelines