Breast and endocrine surgery: thyrotoxicosis in early pregnancy: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Breast and endocrine surgery: thyrotoxicosis in early pregnancy

Sample item

A woman at 7 weeks of pregnancy is diagnosed with Graves disease and is thyrotoxic. Which antithyroid drug is preferred in the first trimester?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Propylthiouracil

Propylthiouracil is preferred in the first trimester because carbimazole and methimazole are associated with embryopathy such as aplasia cutis and choanal atresia. Propylthiouracil is then often switched to carbimazole later because of its hepatotoxicity. Radioiodine is contraindicated in pregnancy.

Option by option

  • A. Propylthiouracil (correct)

    Correct. It has the lowest teratogenic risk during organogenesis.

  • B. Carbimazole

    Carbimazole is associated with congenital malformations in early pregnancy.

  • C. Immediate total thyroidectomy

    Surgery is reserved for failure of drug therapy and is not the first step.

  • D. Radioactive iodine

    Radioiodine crosses the placenta and ablates the fetal thyroid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Propylthiouracil. Propylthiouracil is preferred in the first trimester because carbimazole and methimazole are associated with embryopathy such as aplasia cutis and choanal atresia.

Why is "Carbimazole" not the answer?

Carbimazole is associated with congenital malformations in early pregnancy.

Why is "Immediate total thyroidectomy" not the answer?

Surgery is reserved for failure of drug therapy and is not the first step.

Why is "Radioactive iodine" not the answer?

Radioiodine crosses the placenta and ablates the fetal thyroid.

What concept does this question test?

It tests Breast and endocrine surgery: thyrotoxicosis in early pregnancy in General Surgery. Propylthiouracil is then often switched to carbimazole later because of its hepatotoxicity. Radioiodine is contraindicated in pregnancy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Breast and endocrine surgery: thyrotoxicosis in early pregnancy?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.