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Clinical · Special populations · continued

Second pass at: Pregnancy and pregnancy planning: contraindication and washout posts 61–90

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.

CT
c.tullochTL224 Jan 2026 · edited#61

Coming back to post #57, because the follow-up matters more than the original answer.

Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.

One of those cases where knowing the mechanism does not help the decision.

3 likes 6mo
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KLindqvistTL424 Jan 2026#62
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n.krastevTL224 Jan 2026#63

Small correction to my own earlier position on Pregnancy and pregnancy planning. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.

32 likes 6mo
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d.oyelaranTL3Pharmacist24 Jan 2026#64
TL4_Halvorsen, post #46: Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question. Go to post

Following this. I have the same question and no better information than the first post.

17 likes in reply to #46 6mo
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v.nascimentoTL224 Jan 2026#65
j.mwangi, post #39: Pregnancy and breastfeeding are the clearest cases where the answer is that the trials excluded them and the labelling reflects that exclusion. I would treat that as a working assumption and revisit it. Go to post

I read post #61 twice before replying, because I had assumed the opposite.

Two things can be true about Pregnancy and pregnancy planning at once: the mechanism is plausible and the evidence for the size of the effect is thin. Most of the argument here is people defending the first against attacks on the second.

6 likes in reply to #39 6mo
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n.rahimiTL224 Jan 2026#66

Pregnancy and breastfeeding are the clearest cases where the answer is that the trials excluded them and the labelling reflects that exclusion.

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f.kimaniTL224 Jan 2026#67

Adding the boring version of Pregnancy and pregnancy planning, because the interesting version keeps getting posted and the boring one is usually right.

Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does.

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l.wikstromTL224 Jan 2026#68
r.restrepo, post #56: Post #53 and I disagree about the size of the effect, not about the direction. On Pregnancy and pregnancy planning I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated. Go to post

Before the thread moves on from Pregnancy and pregnancy planning — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.

23 likes in reply to #56 6mo
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d.petrescuTL224 Jan 2026#69

Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.

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j.hartmannTL224 Jan 2026 · edited#70

I disagree with the framing of Pregnancy and pregnancy planning above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

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n.kirchnerTL224 Jan 2026#71
h.lindqvist, post #45: I read post #43 twice before replying, because I had assumed the opposite. The number people quote for Pregnancy and pregnancy planning is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own. Go to post

Post #68 is the version of this I will quote in future. One addition.

The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.

Not the answer, but possibly the question that gets there.

7 likes in reply to #45 6mo
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integrator_traceTL2Member24 Jan 2026#72
c.tulloch, post #61: Coming back to post #57, because the follow-up matters more than the original answer. Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question. One of… Go to post

Nothing to add, except that this is the answer I would give if asked.

18 likes in reply to #61 6mo
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c.nybergTL225 Jan 2026 · edited#73

Checked the Pregnancy and pregnancy planning claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.

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a.schaefferTL2Member25 Jan 2026#74

The honest answer on Pregnancy and pregnancy planning is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.

Most people get the first two right and then argue about the fourth.

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mi.amankwahTL225 Jan 2026#75

Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.

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LJankowiakTL3Regular25 Jan 2026#76
c.lundgren, post #57: Post #54 answers the question as asked. The question underneath it is different. Reporting rather than recommending, on Pregnancy and pregnancy planning. What happened is above. Whether it should have is a different question and not one I am qualified to answer. Go to post

I had written a reply contradicting post #74 and deleted it. Here is what survived.

Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.

Worth one more sentence than it usually gets.

0 likes in reply to #57 6mo
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ak.kravchenkoTL225 Jan 2026#77

Picking up post #76: that is the part I would want checked first.

I read the earlier replies on Pregnancy and pregnancy planning twice before writing this, because I had assumed the opposite and wanted to be sure I was disagreeing with what was said rather than what I expected.

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ambient_draftTL3Regular25 Jan 2026#78

Worth stating the null on Pregnancy and pregnancy planning before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.

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r.sobczakTL225 Jan 2026#79

Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.

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e.almeidaTL2Member25 Jan 2026 · edited#80
m.lehtinen, post #51: Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance. Go to post

Summarising the Pregnancy and pregnancy planning thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.

8 likes in reply to #51 6mo
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d.oyelaranTL3Pharmacist25 Jan 2026#81
f.ibarra, post #26: Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating. Go to post

My position on Pregnancy and pregnancy planning is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

0 likes in reply to #26 6mo
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j.petrovTL225 Jan 2026 · edited#82

Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.

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KLindqvistTL4 Moderator25 Jan 2026#83

Post #79 put the caveat in the right place and I want to underline it.

Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance.

Marking that as an opinion rather than a finding.

10 likes 6mo
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f.kimaniTL225 Jan 2026#84
m.lindqvist, post #55: Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input. The step people skip is the one I have spelled out. Go to post

Noted, and thank you for writing it out rather than summarising it.

3 likes in reply to #55 6mo
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bias_varianceTL4Biostatistician25 Jan 2026#85

Where the Pregnancy and pregnancy planning discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on.

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id.almeidaTL225 Jan 2026#86

Post #83 answers the question as asked. The question underneath it is different.

The arithmetic on Pregnancy and pregnancy planning is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.

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baseline_driftTL225 Jan 2026#87
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n.krastevTL225 Jan 2026#88
n.rahimi, post #66: Pregnancy and breastfeeding are the clearest cases where the answer is that the trials excluded them and the labelling reflects that exclusion. Go to post

If you are new and reading this thread for the answer to Pregnancy and pregnancy planning: the answer is conditional, the conditions are in the third reply, and the rest of the thread is worth skipping.

5 likes in reply to #66 6mo
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two_year_lineTL3Regular25 Jan 2026 · edited#89
r.ekstrom, post #47: Filing a mild objection to the consensus on Pregnancy and pregnancy planning. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Go to post

Useful. I have added it to my own notes with the date on it.

2 likes in reply to #47 6mo
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s.kuuselaTL225 Jan 2026#90

Second-hand on Pregnancy and pregnancy planning, so weight it accordingly — someone whose method I trust told me this and I have not verified it myself.

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