Graves' disease in pregnancy — SCE Endocrinology MCQ

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ModerateThyroidGraves' disease in pregnancySCE Endocrinology

A 30-year-old woman with Graves' disease is 9 weeks pregnant. She had been taking carbimazole 20 mg daily and now has TSH <0.01 mU/L with free T4 31 pmol/L. She has no agranulocytosis history. What is the most appropriate management?

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Correct answer: C — Switch to propylthiouracil during the first trimester and use the lowest effective dose

Switch to propylthiouracil during the first trimester and use the lowest effective dose is best because propylthiouracil is preferred in the first trimester because carbimazole is associated with embryopathy risk. The alternatives are less appropriate because radioiodine is contraindicated; stopping treatment risks maternal and fetal complications; block-and-replace can overtreat the fetus; unchanged carbimazole is less suitable in early pregnancy. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145; BNF