Hyperthyroidism in pregnancy is associated with an increased risk of preeclampsia and for neonatal morbidity, including low birth weight and possibly congenital malformations. Symptoms of hyperthyroidism closely mimic symptoms of normal pregnancy and may consist of nervousness, palpations, heat intolerance, and inability to gain weight despite a good appetite. Thyrotoxicosis in pregnancy may also present as hyperemesis gravidarum.
Hyperthyroidism in pregnancy is treated with propylthiouracil (PTU). The time to onset of action of PTU is generally 4 to 6 weeks to achieve maximum effect. PTU is started at a dose of 100 to 150 mg three times a day and increased as needed to a maximum dose of up to 200 mg three times a day. The goal of therapy is to maintain a free T4 level at the upper range of normal. Approximately 2 percent of patients taking PTU will experience a mild purpuric skin rash within the first 4 weeks of therapy. If this occurs, the PTU should be stopped and replaced with methimazole. Agranulocytosis occurs in about 0.3 percent of patients treated with PTU. If agranulocytosis develops, the PTU should be stopped and methimazole should not be started.
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