Treating hyperthyroidism during pregnancy requires careful consideration to ensure the health and safety of both the mother and the fetus. Here are some general guidelines:

Medications

1. Propylthiouracil (PTU): This is the preferred medication for treating hyperthyroidism during the first trimester of pregnancy. However, due to the risk of liver damage, it’s often switched to methimazole after the first trimester.
2. Methimazole (MMI): This medication is often used after the first trimester, as it’s considered safer for the fetus. However, it’s essential to monitor liver function and adjust the dosage as needed.

Treatment Goals

1. Maintain euthyroidism: The goal is to achieve normal thyroid hormone levels to minimize risks to the mother and fetus.
2. Minimize medication dosage: Use the lowest effective dose to reduce the risk of adverse effects on the fetus.

Monitoring

1. Regular thyroid function tests: Monitor thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels regularly.
2. Fetal monitoring: Regular ultrasound examinations and fetal heart rate monitoring are essential to ensure the fetus’s well-being.

Surgical Treatment

1. Rarely recommended: Surgical treatment is usually reserved for cases where medication is ineffective or not tolerated.
2. Second trimester: If surgery is necessary, it’s typically performed during the second trimester, when the risks to the fetus are lower.

Radioactive Iodine

1. Contraindicated: Radioactive iodine is not recommended during pregnancy, as it can cross the placenta and damage the fetal thyroid gland.

Important Considerations

1. Preconception counseling: Women with hyperthyroidism should receive preconception counseling to discuss treatment options and risks.
2. Collaborative care: Close collaboration between endocrinologists, obstetricians, and primary care physicians is essential to ensure optimal care.

It’s essential to note that each case is unique, and treatment decisions should be individualized based on the patient’s specific needs and circumstances. Pregnant women with hyperthyroidism should work closely with their healthcare providers to develop a personalized treatment plan.