MKSAP: 27-year-old pregnant woman with hypothyroidism
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto thyroiditis that is treated with levothyroxine, 125 µg/d. She also takes prenatal vitamins and iron sulfate.
On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 128/80 mm Hg, pulse rate is 95/min, and respiration rate is 18/min and regular; BMI is 25. She has a mild fine hand tremor. Lung, cardiac, and skin examination findings are normal. The thyroid gland is smooth and slightly enlarged without a bruit or nodules.
Laboratory studies show a serum thyroid-stimulating hormone level of 4.2 µU/mL (4.2 mU/L) and a serum free thyroxine (T4) level of 1.6 ng/dL (21 pmol/L).
Which of the following is the most appropriate management?
A: Increase the levothyroxine dosage by 10% now
B: Increase the levothyroxine dosage by 30% now
C: Repeat thyroid function tests in 5 weeks
D: Repeat thyroid function tests in the second trimester
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Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Endocrinology OB/GYN Source Type: blogs
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