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Acog Practice Bulletin: Thyroid Disease in Pregnancy
Acog Practice Bulletin: Thyroid Disease in Pregnancy
Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the Committee on Practice Bulletins—
Obstetrics with the assistance of Brian M. Casey, MD and Torri D. Metz, MD, MS in collaboration with American Academy of
Family Physicians liaison Jeff Quinlan, MD.
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pregnancy. In addition, propylthiouracil decreases T4 to T3 because of its acute onset, serial leukocyte counts during
conversion and is used preferentially for T3-predominant therapy are not helpful. Thus, if fever or sore throat develops,
thyrotoxicosis (4). Decision making regarding whether women are instructed to discontinue use of the medication
and how to transition from one agent to another often immediately and report for a complete blood count (50).
occurs in conjunction with endocrinology or maternal– The initial thioamide dosing is empirical. If pro-
fetal medicine subspecialists. If a switch is deemed pylthiouracil is selected, an oral dosage of 100–600 mg
appropriate, a dose ratio of 20:1 propylthiouracil to me- daily, divided into three doses, may be initiated, depend-
thimazole is recommended (Fig. 1). ing on clinical severity (3). A typical dose in the average
Transient leukopenia occurs in up to 10% of pregnant patient is 200-400 mg daily. If methimazole is used, an
women who take thioamide drugs, but this situation does not initial daily dosage of 5–30 mg orally, divided into two
require therapy cessation. In less than 1% of patients who doses, is recommended (although the frequency may
take thioamide drugs, however, agranulocytosis develops be reduced to one daily dose as maintenance therapy is
suddenly and mandates discontinuation of the drugs. The established). The goal is treatment with the lowest
development of agranulocytosis is not related to dosage, and possible thioamide dose to maintain free T4 levels
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