A patient in her twenties with Graves' disease who takes methimazole (Tapazole) tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her?
a. Methimazole is safe to take throughout pregnancy.
b. Propylthiouracil should be taken throughout her pregnancy.
c. The patient should discuss changing to propylthiouracil from now until her second trimester with her provider.
d. The patient should discuss therapy with iodine-131 instead of medications with her provider.
ANS: C
Methimazole is not safe during the first trimester of pregnancy, because it is associated with neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third trimesters. Propylthiouracil is recommended for pregnant patients only in the first trimester and during lactation only if a thionamide is absolutely necessary. Iodine-131 is used in women older than 30 years who have not responded to medication therapy and is contraindicated during pregnancy.
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