But that would be the other option if she, let's say, wanted to get pregnant earlier or did not want to have the risk of the radioactive iodine therapy.

The other option would be to continue the methimazole for a year to 18 months.

So if this was outside of pregnancy, you would treat her for 18 months, hope that she goes into remission and you can follow her traps by going down.

So the other option would be to treat her for 12 months, see what happens with her trabs, see what dose she gets on the methimazole.

And then theoretically, you could stop it as soon as she knew she was pregnant and reintroduce it in second trimester if needed.

So it is the other option.

Congenital anomaly rates with methimazole are 9%.

Dr. Kili, can you please summarize some of the main key learning points that we brought up today?

What are your recommendations to this patient to minimize her risk of further episodes of diabetic ketoacidosis?

Yeah, I think the first thing you want to do is to really understand the root cause of her diabetic ketoacidosis.

So she's working hard.

She's wearing a Dexcom.

She's taking multiple doses of insulin.

She's counting her carbohydrates, but she's still ending up in DKA.

And I think you have to give her space to acknowledge why that might be, because it could be cost.

And then sort of once she's resolved, really looking at why is she having so much difficulty with eating? Does she have some gastroparesis? Has she got nausea and vomiting in pregnancy that we need to manage? It's something that she's able to kind of keep her carbohydrate down and then obviously making sure that she's gone the doses that work for her to keep her within

What are your recommendations to this patient to minimize her risk of further episodes of diabetic ketoacidosis?

Yeah, I think the first thing you want to do is to really understand the root cause of her diabetic ketoacidosis.

So she's working hard.

She's wearing a Dexcom.

She's taking multiple doses of insulin.

She's counting her carbohydrates, but she's still ending up in DKA.

And I think you have to give her space to acknowledge why that might be, because it could be cost.

And then sort of once she's resolved, really looking at why is she having so much difficulty with eating? Does she have some gastroparesis? Has she got nausea and vomiting in pregnancy that we need to manage? It's something that she's able to kind of keep her carbohydrate down and then obviously making sure that she's gone the doses that work for her to keep her within