title: Therapy of hyperthyroidism in pregnancy and breastfeeding.
abstract: 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.
  
  
  BACKGROUND
  Obstetricians & Gynecologists, Family Physicians
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. angela.fumarola@uniroma1.it
authors.forename: Angela
authors.initials: A
authors.lastname: Fumarola
authors.forename: Agnese
authors.initials: A
authors.lastname: Di Fiore
authors.forename: Michela
authors.initials: M
authors.lastname: Dainelli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Grani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carbotta
authors.forename: Anna
authors.initials: A
authors.lastname: Calvanese
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001942:Breast Feeding; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D007455:Iodine / Q000627:therapeutic use; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D013854:Thioamides / Q000009:adverse effects / Q000627:therapeutic use*; D013958:Thyroid Crisis / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D013854:Thioamides; D007455:Iodine