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Hyperthyroidism

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25 104. Patients receiving ATD for GD when becoming pregnant or found to have GD during pregnancy should have TRAb levels measured at initial pregnancy visit or at diagnosis using a sensitive assay and, if elevated, again at 18–22 weeks of gestation. (S-L) 105. Patients with elevated TRAb levels at 18–22 weeks of gestation should have TRAb remeasured in late pregnancy (weeks 30–34) to guide decisions regarding neonatal monitoring. An exception to this is a woman with an intact thyroid who is no longer in need of ATD therapy. (S-L) Postpartum Thyroiditis 106. In women developing thyrotoxicosis after delivery, selective diagnostic studies should be performed to distinguish postpartum destructive thyroiditis from postpartum GD. (S-L) 107. In women with symptomatic thyrotoxicosis from postpartum destructive thyroiditis, the judicious use of β-adrenergic blocking agents is recommended. (S-L) 108. In pregnant women diagnosed with hyperthyroidism due to multinodular thyroid autonomy or a solitary toxic adenoma, special care should be taken not to induce fetal hypothyroidism by ATD therapy. (S-L)

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