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Therapy of Hyperthyroidism in Pregnancy and Breastfeeding

Fumarola, Angela MD*; Di Fiore, Agnese MD; Dainelli, Michela MD; Grani, Giorgio MD§; Carbotta, Giovanni MD§; Calvanese, Anna MD

Obstetrical & Gynecological Survey: June 2011 - Volume 66 - Issue 6 - p 378-385
doi: 10.1097/OGX.0b013e31822c6388

Uncontrolled hyperthyroidism in pregnancy is associated with an increased risk of perinatal complications. The state of the art discussed here has been derived through a wide MEDLINE search throughout English-language literature by using a combination of words such as hyperthyroidism, propylthiouracil (PTU), methimazole, rituximab, and pregnancy to identify original related works and review articles. Thioamides are the main first-line therapeutic options, whereas beta-blockers and iodine are second-choice drugs; surgery is resorted to only in exceptional cases. Methimazole and PTU reduce the production of thyroid hormones by selectively inhibiting thyroid peroxidase. PTU was once considered to be the first-choice drug in the treatment of gestational hyperthyroidism; however, the United States Food and Drug Administration now recommends it as a second-line thioamide, which should be used solely by women in their first trimester of pregnancy. Thyroidectomy is to be carried out only in pregnant women affected by life-threatening, uncontrollable hyperthyroidism, or in cases with thioamide intolerance.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the physician should be better able to choose appropriate therapies for hyperthyroidism in pregnant women, assess the risk of possible complications due to maternal hyperthyroidism, and evaluate strategies for patient follow-up.

*Research Professor of Endocrinology; †Physician, PhD Student; ‡Physician; §Physician, Resident; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

All authors have disclosed that the use of Rituximab for the treatment of Graves ' Orbitopathy as discussed in this article has not been approved by the US Food and Drug Administration.

Correspondence requests to: Angela Fumarola, MD, Department of Experimental Medicine, Sapienza Università di Roma, V.le Regina Elena, 324, 00161 Rome, Italy. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.