Graves' disease in pregnancy — SCE Endocrinology MCQ

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ModerateThyroidGraves' disease in pregnancySCE Endocrinology

A 28-year-old woman at 8 weeks' gestation has Graves' disease relapse. TSH is <0.01 mU/L, free T4 is 36 pmol/L and TSH receptor antibodies are positive. She has no thyroid eye disease and is haemodynamically stable. What is the most appropriate management?

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Correct answer: B — Start propylthiouracil and plan review of therapy after the first trimester

Propylthiouracil is generally preferred in the first trimester because carbimazole is associated with embryopathy risk, with later review because PTU carries hepatotoxicity risk. Radioiodine is contraindicated in pregnancy. The pearl is that trimester timing matters in Graves' disease.

Reference: BNF, NICE NG145, British Thyroid Association pregnancy guidance