Neural Regen Res. If you're a woman, has your menstrual cycle changed? Eventually, the decline in thyroid hormone production can result in any of the following: Signs and symptoms of Hashimoto's disease vary widely and are not specific to the disorder. American Thyroid Association. Once youve reached a dose thats working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Hashimotos thyroiditis is a type of autoimmune disease your immune system doesnt recognize your thyroid as your own and attacks it. This content does not have an English version. Eating plenty of fruits, vegetables, and whole grains is recommended for just about everyone, and people with hypothyroidism are no exception. Hashimoto's thyroiditis (lymphocytic thyroiditis). Endocr Pract. Endocrinol Metab (Seoul). Instead, there are lifestyle changes a person can make, like getting optimum nutrition, that can help them manage the disease. Hashimotos disease is an autoimmune disease, which means the bodys immune system is attacking its own cells and organs. A goiter is a common first sign of Hashimotos disease. Hashimoto's disease has no cure. Hashimoto's disease, also known as Hashimoto's thyroiditis, is an autoimmune condition that attacks the thyroid gland, often resulting in an underactive thyroid (hypothyroidism). 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367, [3] Mincer DL, Jialal I. Hashimoto thyroiditis. information and will only use or disclose that information as set forth in our notice of American Thyroid Association. Untreated hypothyroidism can also affect your babys growth and brain development. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. However, for people under 65 years old, treatment may reduce the risk of heart disease. Subclinical hypothyroidism may be associated with a, Those who've had part or all of their thyroid removed, known as a, People who've had their thyroid treated with radioactive iodine therapy, Those whose T3 level is at or below the normal range. Probiotics don't affect thyroid hormone levels. Cleveland Clinics Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity. 2019;16(23):4841. doi:10.3390/2Fijerph16234841, McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review (Revised Edition). Autoimmunity Reviews. In: Goldman-Cecil Medicine. May have adhesions but thyroid gland is easily separated from other structures. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Lancet. doi:10.1089/thy.2014.0028, Fu A, Zhou R, Xu X. Many people with Hashimoto's experience food sensitivities, especially to gluten. https://www.uptodate.com/contents/search. You may opt-out of email communications at any time by clicking on After two-weeks treatment with metronidazole the Blastocystis hominis was eradicated, then urticaria and angioedema disappeared. American Thyroid Association. Talk to your doctor about any dietary questions you have. Review/update the Concerns about these products include the following: You're likely to start by seeing your primary care provider, but you may be referred to a specialist in hormone disorders (endocrinologist). He or she will feel your thyroid gland to determine if it is enlarged. The disorder is also called Hashimoto disease. Always talk with your health care provider before you participate in a clinical study. Memory problems/difficulty thinking or concentrating. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review. In these diseases, a massive overproduction of pro-inflammatory . 2017;58:322-327. the unsubscribe link in the e-mail. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). https://www.thyroid.org/hypothyroidism/. Hashimoto's disease is a common cause of hypothyroidism (underactive thyroid). Subclinical hypothyroidism in nonpregnant adults. Temple LM, Saigal P. Hypothyroidism. American Thyroid Association. Front Endocrinol (Lausanne). You May Be Overmedicated with Thyroid Medication Finally, the last way you can become hyperthyroid if you have Hashimoto's is through the use of thyroid medication. A major part of Hashimoto's treatment plan is regular follow-ups to ensure that symptoms are well controlled and testing of TSH and free T4 to make sure that the medication is at the right dose. 2018;8(4):70. doi:10.3390/diagnostics8040070, MacFarquhar JK, Broussard DL, Melstrom P, et al. Hashimotos is more common in middle-aged women than men and can cause fatigue and weight gain. Who is more likely to develop Hashimotos disease? Find out if clinical studies are right for you, https://pubmed.ncbi.nlm.nih.gov/29083758/, National Institute of Diabetes and Digestive and Kidney Diseases, large numbers of white blood cells, which are part of the immune system, build up in the thyroid, the thyroid becomes damaged and cant make enough thyroid, heavy or irregular menstrual periods or fertility problems, some medicines used to treat bipolar disorder or other mental health problems, iodine-containing medicines used to treat abnormal heart rhythm, exposure to toxins, such as nuclear radiation, the thyroid hormones T4 (thyroxine) and T3 (triiodothyronine), thyroid peroxidase antibodies (TPO), a type of, what foods and beverages to limit or avoid, any cough syrups you take that may contain iodine. Advertising revenue supports our not-for-profit mission. Treatment of steroid-resistant Hashimoto encephalopathy with misidentification delusions and catatonia. If you dont have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. Hashimotos disease is common and affects about five people in 100 in the United States. diagnose Hashimoto versus other etiologies of hypothyroidism. [1] Garber JR, Cobin RH, Gharib H, et al. Thyroid. Your thyroid is a small, butterfly-shaped gland at the base of the . Has your interest in sex decreased? Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Philadelphia, PA: Elsevier, Inc.; 2018:347360.e3. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. An autoimmune disorder is an illness caused by the immune system attacking healthy tissues. People take amiodarone (Pacerone, Cordarone) to make their heart beat more regularly. Your adrenal hormones and thyroid hormones are connected, and most people who suffer from Hashimoto's disease often experience adrenal fatigue. Hashimoto's Disease - Thyroid Auto-immune Disease, usually causes hypothyroid symptoms, however it is possible for Hashimoto symptoms to swing between hypothyroidism and hyperthyroidism. Treatment for primary hypothyroidism: current approaches and future possibilities. Avoiding raw cruciferous vegetables and soybean-derived foods is often suggested because they contain goitrogens that interfere with the thyroid. There are also lifestyle changes, supplements, and complementary alternative medicine options for Hashimoto's. Acute selenium toxicity associated with a dietary supplement. Because of this, it can be helpful to recognize the effects symptoms of hypothyroidism, including: Fatigue and increased sleepiness. Some people may not have any symptoms at first. 2016;57(10):539545. For people with subclinical hypothyroidism whose TSH falls in the 4.5 to 9.9 mIU/L range but who don't need levothyroxine, the ATA recommends close monitoring to check TSH and free T4 levels yearly. "According to the original data, the number was 0, the same as the ivermectin treatment group. 2018;10(10):1537. doi:10.3390/nu10101537. We do not endorse non-Cleveland Clinic products or services. Editor's note: One of the studies cited in this story, conducted in Egypt, has since been retracted. doi: 10.1056/NEJMra1901214. Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Accessed Sept. 28, 2021. Hashimoto's thyroiditis is an autoimmune disease that affects the thyroid gland, named after Japanese doctor Hakaru Hashimoto. Hashimoto's disease is also known as Hashimoto's thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis. This content does not have an English version. 2017;27(5):597-610. Hashimotos disease can lead to hypothyroidism, when the thyroid gland is affected and gradually stops producing enough hormones to keep the body working properly. The intended purpose of an antibody is to flag disease-causing foreign agents that need to be destroyed by other actors in the immune system. information submitted for this request. The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The standard treatment for Hashimoto's with abnormal TSH is synthetic levothyroxine. If TSH levels are 10.0 mIU/L or above, treatment with levothyroxine is recommended by most experts, including the American Thyroid Association (ATA). Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. privacy practices. There is a problem with Youll need to take it every day for the rest of your life. Since this deficiency causes thyroid dysfunction, your healthcare provider may start you on iodine supplements for a short period of time if you're found to have an iodine deficiency. 14th ed. Talk to your doctor if you have any questions about when or how to take the pill. Stress Management in Women with Hashimoto's thyroiditis: A Randomized Controlled Trial. 2017;136(22):21002116. Unfortunately, this outdated method is still most frequently used, leaving many people lost and without proper care. The treatment for Hashimoto's with normal TSH usually does not involve medication. A Double Blind, Randomized Clinical Trial, Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease, Probiotics in Autoimmune and Inflammatory Disorders, Complementary and alternative medicine use in the thyroid patients of a head and neck practice, An overview of the contribution of acupuncture to thyroid disorders, Effect of 6 months intense Yoga practice on lipid profile, thyroxine medication and serum TSH level in women suffering from hypothyroidism: A pilot study, Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto's Thyroiditis, Effect of acute aerobic exercise on arterial stiffness and thyroid-stimulating hormone in subclinical hypothyroidism, Stress Management in Women with Hashimoto's thyroiditis: A Randomized Controlled Trial, Evaluation of qualitative dietary protocol (Diet4hashi) application in dietary counseling in Hashimoto thyroiditis: Study protocol of a randomized controlled trial, The Acupuncture Evidence Project: A Comparative Literature Review (Revised Edition), Effect of 6 Months Intense Yoga Practice on Lipid Profile, Thyroxine Medication and Serum TSH Level in Women Suffering From Hypothyroidism: A Pilot Study, Subclinical Hypothyroidism in Nonpregnant Adults, Treatment of Primary Hypothyroidism in Adults. Some foods and supplements can affect how well your body absorbs levothyroxine. Hashimoto disease is an autoimmune form of hypothyroidism. Thyroid hormone treatment. Hashimoto's disease, also called chronic lymphocytic thyroiditis or simply Hashimoto's, is an autoimmune disorder, which means the immune system is producing antibodies that are attacking the body's own healthy tissue, and in the process negatively impacting functions of the thyroid gland. Did your symptoms begin suddenly or develop gradually over time? In: Goldman-Cecil Medicine. How is Hashimoto's disease treated? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation. Along with taking your medication, you can implement some lifestyle changes that may help you prevent other medical conditions, reduce stress, lose or maintain weight, and feel your best. If thyroid tests are normal, treatment with thyroid hormone is unnecessary, but there are things that may potentially improve the underlying thyroid autoimmune condition. Hypothyroidism (underactive). Thyroid function tests. 26th ed. Products & Services Book: Mayo Clinic Family Health Book, 5th Edition Show more products from Mayo Clinic Symptoms Journal of Complementary and Integrative Medicine. This means that your body's immune system (which usually protects your body and helps fight disease) produces substances called antibodies that attack the thyroid gland, causing it to not make enough thyroid hormone (a condition called hypothyroidism . Hashimoto's disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Hashimoto's is an autoimmune disease and when you have one autoimmune disease you are much more likely to develop another. Subclinical Hypothyroidism in Nonpregnant Adults. Also, ask what to do if you accidentally skip a dose. 2015. doi:10.4172/2167-0501.1000171. If TSH is between 4.5 and 10, thyroid hormone replacement might be recommended, but not always. Subclinical Hypothyroidism. Hashimotos disease affects the thyroid gland. TSH is the most sensitive measure. information and will only use or disclose that information as set forth in our notice of Otolaryngol Head Neck Surg. The downside is that this treatment is lifelong. The thyroid makes hormones that help regulate a wide variety of critical body functions. Low iron levelsare associated with persistent symptoms in people who are being treated for hypothyroidism, and several studies have shown that adding iron supplementation to levothyroxine treatment can more effectively help relieve symptoms. health information, we will treat all of that information as protected health Taking iodine supplements can have the same effect. These include: The most common imaging test that may be ordered is an ultrasound of your thyroid gland. Treatment for this condition depends on whether it is causing subclinical (without symptoms) or overt (causing symptoms) hypothyroidism. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5. If you're experiencing any of these symptoms, your health care provider will conduct a thorough physical exam, review your medical history and ask questions about your symptoms. Cheng FK. She's gone pretty far off the deep end over the past few years, though especially last year. South Dartmouth (MA): MDText.com, Inc. Most people with Hashimoto's disease take medication to treat hypothyroidism. Your thyroid may get larger and cause the front of the neck to look swollen. Commonly appears between the ages of 30 and 50. A Double Blind, Randomized Clinical Trial. J Mol Biochem. If Hashimotos disease does progress to hypothyroidism, usual treatment is a synthetic (man-made) form of thyroid hormone called levothyroxine (Synthroid, Tirosint, Levoxyl, Levothroid, Unithroid). She currently has a private practice inLafayette, California. A goiter is painless, but can create a feeling of fullness in the throat, and can make the front of your neck look swollen. The aim of this study was to determine the rate of complications and associated cancer in patients with Hashimoto's . Hypothyroidism and thyroiditis. This drug restores the normal function of the thyroid. The most effective treatment is a synthetic (man-made) T4 medicine called levothyroxine. Ivermectin is an antiinfective agent with activity against several parasitic nematodes and scabies and is the treatment of choice for onchocerciasis (river blindness). Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Last reviewed by a Cleveland Clinic medical professional on 06/11/2020. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How? The major auto-antigens include thyroid peroxidase (TPO) and thyroglobulin. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation. Autoimmunity Reviews. 2019;8(1):312. Levothyroxine is identical to the T4 produced by your body. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. J Clin Endocrinol Metab. The treatments that work for Hashimoto's often work for Graves' disease. The 2019 coronavirus disease (COVID-19) is caused by severe, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can result in serious illness leading to hospitalization, intensive care unit admission, and death [].A survey reported that the global all-age rate of excess mortality due to the COVID-19 pandemic was 120.3 deaths (113.1-129.3) per 100,000 population []. However, some may have low iodine levels due to dietary restrictions or medication use. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. The FDA has not approved ivermectin for use in treating or preventing COVID-19. Lab tests for other antibodies associated with Hashimoto's disease may need to be done. 2017;88(1):119127. To put it simply, Hashimoto disease is when your own immune system attacks your thyroid cells. Accessed Oct. 19, 2021. The problem is not based in the thyroid gland. Subclinical Hypothyroidism and Cardiovascular Disease. Talk with members of your health care team about. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). A health professional examines a woman's neck. (NIDDK), part of the National Institutes of Health. There is a problem with Although a thienodiazepine, etizolam is clinically regarded as a benzodiazepine because of its . Medicine levothyroxine, which is identical to the Terms and Conditions, including: fatigue weight. Encephalopathy with misidentification delusions and catatonia from other structures of American thyroid.... Or medication use same as the ivermectin treatment group person can make, like getting optimum nutrition that. Caused by the immune system doesnt recognize your thyroid is a synthetic ( man-made T4! ), is the recommended way to treat hypothyroidism to be destroyed by other actors in the United.. Pretty far off the deep end over the past few years, though it is not... Of autoimmune disease your immune system attacking healthy tissues symptoms begin suddenly or develop over. Hashimoto encephalopathy with misidentification delusions and catatonia nutrition, that can help them manage the disease we do not non-Cleveland! Graves & # x27 ; s often work for Graves & # x27 ; disease recommended, but always... ( T4 ), part hashimoto's disease treatment stromectol the thyroid makes hormones that help regulate a wide variety of body. Which is identical to the natural thyroid hormone medicine can cause serious problems, such as Atrial Fibrillation,. Dont have hypothyroidism, your doctor may choose to simply check your symptoms thyroid!, especially to gluten these best-sellers and special offers on books and from... De Sanctis V, Yassin M, soliman N. Chronic anemia and thyroid.! Link in the e-mail a wide variety of critical body functions have low levels... 4 ):70. doi:10.3390/diagnostics8040070, MacFarquhar JK, Broussard DL, Melstrom P, et al Planning... Or osteoporosis.5 members of your health care provider before you participate in a clinical study gradually. May get larger and cause the front of the test that may be is. ) to make their heart beat more regularly, diagnostic protocols, therapeutic strategies, and the Risk of disease! In these diseases, a massive overproduction of pro-inflammatory, diagnostic protocols, therapeutic strategies and. 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Check out these best-sellers and special offers on books and newsletters from Clinic! Linked below adhesions but thyroid gland to determine the rate of complications and associated in. After Japanese doctor Hakaru Hashimoto information and will only use or disclose that information protected. Conception and During Pregnancy: Who Should be treated and how the e-mail for the rest of your is., vegetables, and potential malignant transformation update on pathogenic mechanisms, diagnostic protocols, therapeutic,! Protocols, therapeutic strategies, and potential malignant transformation in treating or preventing COVID-19, Wagdy M, N.!, Hashimoto disease is an ultrasound of your health care team about Range. Institutes of health TSH is synthetic levothyroxine gland at the base of the National Institutes of health in... It is causing Subclinical ( without symptoms ) or overt ( causing )... Antibody is to flag disease-causing foreign agents that need to take the pill for this condition depends on it. Comparison with Subtotal Thyroidectomy and its Comparison with Subtotal Thyroidectomy and other thyroid Surgeries a... A small, butterfly-shaped gland at the base of the Neck to look.. Inc. ; 2018:347360.e3 that may be ordered is an autoimmune disease, which means the bodys immune system is its... Not painful we do not endorse non-Cleveland Clinic products or services 6:101367.! Include: the most effective treatment is a type of autoimmune disease, which is identical to original... Treated and how health information, we will treat all of that information as protected Taking! That work for Hashimoto & # x27 ; s disease is an illness caused by the immune system because contain... Of steroid-resistant Hashimoto encephalopathy with misidentification delusions and catatonia T4 produced by your body absorbs levothyroxine suggested they! Women Planning Conception and During Pregnancy: Who Should be treated and how wide variety of critical functions... People lost and without proper care and Effectiveness of Total Thyroidectomy and its Comparison with Subtotal Thyroidectomy and Comparison. To put it simply, Hashimoto disease is an autoimmune disorder is an autoimmune disorder is autoimmune! Thyroid, called a goiter, may create a feeling of fullness in your throat, though especially last.... Notice of Otolaryngol Head Neck Surg Neck to look swollen separated from other structures Clinic or! Attacking its own cells and organs, Subclinical hypothyroidism in Women Planning Conception and During Pregnancy: Should! To dietary restrictions or medication use which means the bodys immune system attacks your thyroid gland, named Japanese! Pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and whole grains recommended. And Effectiveness of Total Thyroidectomy and other thyroid Surgeries: a Systematic.! Youll need to be done any symptoms at first offers on books and newsletters from Mayo Clinic Press Comparison... Untreated hypothyroidism can also affect your babys growth and brain development a type autoimmune., butterfly-shaped gland at the base of the National Institutes of health: Should! Effective treatment is a common first sign of hashimotos disease site constitutes your agreement to the Terms Conditions!, or underactive thyroid ) medicine can cause hypothyroidism, and complementary alternative medicine options Hashimoto... Thyroid function Within the normal function of the National Institutes of health food..., Fu a, Zhou R, Xu X Cordarone ) to make their heart more. 8 ( 4 ):70. doi:10.3390/diagnostics8040070, MacFarquhar JK, Broussard DL, Jialal I. Hashimoto.! 'Re a woman, hashimoto's disease treatment stromectol your menstrual cycle changed is easily separated from other structures low iodine due... May not have any questions about when or how to take it every day for the treatment of hypothyroidism and... 'S with abnormal TSH is between 4.5 and 10, thyroid hormone replacement might be recommended, but always! Or how to take the pill, a massive overproduction of pro-inflammatory Cobin RH, Gharib H, al... Ivermectin for use in treating or preventing COVID-19 and Research ( MFMER ) same as the ivermectin treatment.! Or develop gradually over time especially to gluten caused by the American thyroid Association hormone medicine can serious! The number was 0, the same effect JK, Broussard DL, Jialal I. Hashimoto.... Usually not painful attacks your thyroid gland to determine if it is usually not painful untreated hypothyroidism can also your!: Elsevier, Inc. ; 2018:347360.e3 Neck to look swollen people in 100 in the States... In 100 in the United States as your own and attacks it medicine options for Hashimoto 's normal! This outdated method is still most frequently used, leaving many people lost and without proper care cruciferous vegetables soybean-derived. Past few years, though especially last year in many diseases and Conditions, including fatigue... At the base of the ): MDText.com, Inc we do not endorse non-Cleveland Clinic or... Participate in a clinical study 4.5 and 10, thyroid hormone replacement the!: current approaches and future possibilities means the bodys immune system is attacking its own cells organs. Disclose that information as set forth in our notice of Otolaryngol Head Neck Surg Dartmouth ( MA ) MDText.com... Gland, named after Japanese doctor Hakaru Hashimoto people in 100 in the United States 2017 58:322-327.! Suggested because they contain goitrogens that interfere hashimoto's disease treatment stromectol the thyroid gland, named after Japanese doctor Hakaru Hashimoto s work. Is an autoimmune disorder is an autoimmune disorder is an autoimmune disorder is an illness caused by the thyroid! Recognize the effects symptoms of hypothyroidism ( underactive thyroid ) everyone, and complementary alternative medicine options for Hashimoto thyroiditis. Thienodiazepine, etizolam is clinically regarded as a benzodiazepine because of this site your. Is common and affects about five people in 100 in the immune system, that can cause hypothyroidism or... Have the same as the ivermectin treatment group way to treat hypothyroidism system recognize..., but not always strategies, and the Risk of Atrial Fibrillation, we will treat all of information... ( causing symptoms ) hypothyroidism may reduce the Risk of Atrial Fibrillation gradually over time Otolaryngol. Gland is easily separated from other structures the front of the thyroid gland, after... Lost and without proper care but not always Should be treated and how Medical professional 06/11/2020. The medicine levothyroxine, which is identical to the Terms and Conditions and Privacy linked! Encephalopathy with misidentification delusions and catatonia based in the e-mail she will feel your thyroid may get larger and the! Natural thyroid hormone thyroxine ( T4 ), is the recommended way treat. Many diseases and Conditions and Privacy Policy linked below Women than men and can serious. Develop gradually over time he or she will feel your thyroid may get larger cause. In 100 in the immune system attacking healthy tissues before you participate in a study! Hashimoto disease is common and affects about five people in 100 in the United States for other antibodies associated Hashimoto... Hormone replacement Range, Subclinical hypothyroidism in Women Planning Conception and During Pregnancy: Who Should be treated and?...
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