How is hyperthyroidism during pregnancy treated?

  1. ATD therapy: ATD therapy can be given throughout the pregnancy. Because ATD can affect fetal thyroid function through the placenta, it is important to monitor the pregnant woman’s thyroid hormone levels to determine the amount of ATD needed for treatment. PTU is preferred because the drug does not easily pass through the placenta. 300 mg/d of PTU for initial treatment and 50-150 mg/d for maintenance is safe for the fetus. Serum FT4 should be maintained at the upper limit of normal values. In addition, during the second 6 months of pregnancy, the dose of ATD can be reduced due to the immunosuppressive effects of pregnancy. After delivery, immunosuppression is lifted, hyperthyroidism is easy to recur and the need for ATD increases.  2.Surgical treatment: For hyperthyroidism occurring in the first trimester, after controlling the symptoms of hyperthyroidism by PTU treatment, a subtotal removal of both thyroid glands can be chosen in the middle trimester.  3. ATD treatment during breastfeeding: Since the proportion of PTU passing through the placenta and entering breast milk is less than that of MMI, PTU should be preferred, and it is generally believed that PTU 300mg/d is safe for infants.  4. ATD therapy combined with L-T4 cannot prevent the occurrence of fetal hypothyroidism because the amount of the latter passing through the placenta is very small.  5. RAI therapy is contraindicated during pregnancy.  6. Maternal TSAb causes neonatal hyperthyroidism through the placenta, which is self-limiting in mild cases and does not require treatment.