A 25-year-old woman who was 4 months pregnant presented with weight loss of 3 kg over the previous 4 weeks, associated with intermittent palpitations, tremor and feeling of warmth. She was not taking any medication.
On examination, her pulse was 100 beats per minute and regular, and her blood pressure was 130/60 mmHg. A symmetrical non-tender goitre was palpable, with an audible bruit. There was no exophthalmos.
Investigations:
serum thyroid-stimulating hormone<0.1 mU/L (0.4C5.0)
serum free T445.2 pmol/L (10.0C22.0)
serum free T322.8 pmol/L (3.0C7.0)
anti-thyroid stimulating hormone receptor
antibodies40 U/L (<7)
What is the most appropriate treatment?
A . carbimazole
B . propranolol
C . propylthiouracil
D . radioactive iodine
E . subtotal thyroidectomy
Answer: A
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