What is the recommended treatment for overt hyperthyroidism in the first trimester of pregnancy?

The recommended treatment for overt hyperthyroidism in the first trimester of pregnancy is propylthiouracil (PTU). This preference stems from PTU's safety profile during early pregnancy compared to other antithyroid medications.

Methimazole, while effective, has been associated with risks during the first trimester, including potential teratogenic effects such as congenital aplasia cutis and other skeletal anomalies. Consequently, its use is generally avoided during this critical period of fetal development.

Radioactive iodine is contraindicated in pregnancy because it can cause fetal thyroid dysfunction and potentially lead to severe complications.

Beta-blockers may be used for symptomatic relief, especially in cases of severe hyperthyroidism, but they do not address the underlying cause of hyperthyroidism itself; therefore, they are not considered a definitive treatment.

In summary, PTU is the preferred choice for managing overt hyperthyroidism in early pregnancy due to its established safety profile compared to other treatments.