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 Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Endocrinology OB/GYN Source Type: blogs