Endo

Question 1

If a mother with grave’s disease has a fetus that needs treatment for signs of hyperthyroidism, what medications can be used and when? What their side effects?

Answer 1

First trimester, use propylthiouracil (PPU). Think PPU used during PRIMARY trimester.
- Side effects are milder: pre auricular sinus/fistula, low BW, urinary tract anomalies

Second and third trimester, use methimazole (MMI). Think MMI used during MAJORITY of pregnancy (2nd and 3rd).
- Side effects more severe: cutis aplasia, choanal atresia, GI defects so makes sense wouldn’t want to use it during first trimester

Question 2

Meds for neonatal hyperthyroidism. Name the 5 and when to consider them.

Answer 2

Methimazole: first line treatment. Dec TH synthesis by inhibiting thyroid peroxidase (hopefully don’t need to know MOA but have it here just in case)

Propylthiouracil (PTU): no longer first line 2/2 risk of liver failure. Inhibits thyroid peroxidase and inhibit peripheral T4 to T3 conv.

BB: use if hemodynamically unstable. Inhibit peripheral T4 to T3 conv.

K iodide (lugol’s solution): use if hemodynamically unstable. rapidly inhibits TH synthesis and release.

Glucocorticoids: use if severe hyperthyroidism to decrease TH secretion and block peripheral T4 to T3 conv.

**average length of therapy 1-2 months. If treat early, have excellent outcome. But if untreated clinical hyperthyroidism, have 15% mortality rate!!