Thyroid Disease In pregnancy

A 33 yo G4P2013 at 38w GA with GDMA2 complains of fatigue and cold intolerance. Which of the following is the MOST accurate when describing TSH levels in 3rd trimester?

• Decreased due to maternal increased hCG level

• Unchanged from baseline

• Increased due to increased production of placental deiodinase

• Decreased due to increased production of placental deiodinase

• Increased due to maternal decreased hCG level

A 24yo G1 at 26w presents for swelling in her neck, tachycardia, palpitations, heat intolerance. She has no personal or family history of thyroid disease. Her BP is 140/90, HR 104. Exam does not demonstrate ophthalmopathy, but you notice some fullness of her thyroid gland on the right. TSH <0.02mIU.L and free T4 is high at 5.0ng/dL. Best next step is administration of:

• Desiccated thryoid
• Levothyroxine
• Methimazole
• Propranolol

A 28yo G1 presents at 16w of gestation presents for prenatal care appointment. She reports increasing constipation, fatigue, and hair loss. She has no history of thyroid disease, Her TSH is 5mIU/L and free T4 is 0.6ng/dL. Best management option for this patient is:

• Docusate sodium
• Methimazole
• Propylthouracil
• Levothyroxine

A 29yo G1P0 at 9w gestation with heart palpitations, heat intolerance, and tremors in her hands. She also reports severe nausea and frequent episodes of emesis. She has lost 3lbs during pregnancy. On pelvic exam, her uterus is consistent with 9 weeks of gestation. On physical exam, she has a symmetrically enlarged, smooth, and painless thyroid gland. She has a TSH concentration of 0.01mIU/mL and free T4 of 9.5 ng/mL. The best next step in evaluation of this patient is to measure her

• human chorionic gonadtropin
• free T4 index
• free T3
• thyroid peroxidase antibodies
• TSH-receptor antibodies

A 23yo woman comes to your office for a prepregnancy visit. She has unintentionally lost 9kg (20lb) over 2 months without any change in diet or level of activity. Your exam shows a temperature of 37 C (98.6 F), blood pressure of 142/92 mmHg, and heart rate of 110 bpm. You suspect she has a thyroid disorder and order TSH and free T4. The changes in laboratory values that would support your clinic suspcion are

• decreased TSH, normal free T4
• decreased TSH, elevated free T4
• elevated TSH, decreased free T4
• elevated TSH, normal free T4
• normal TSH, elevated free T4

A 33yo G2P2 presents for her annual well-woman exam. Her only concern is related to thyroid disease. She is worried that she could have thyroid problems because her paternal grandmother did. Her BMI is 21. She denies any hair or skin changes and reports feeling tired but proud of her new excercise routine. Physical exam findings are all within normal limits. The best next course of action is

• TSH testing
• Thyroid ultrasonography
• Routine follow-up in 1 year
• Serum iodine level testing
• antithyroid peroxidase antibody testing

A 24yo G1 presents to the clinic with a positive pregnancy test. She has a medical history of Graves disease that was successfully treated wth radioactive iodine ablation. A repeat pregnancy test is positive, and her levothyroxine dose is increased. At which gestation age does the fetus begin synthesizing thyroid hormone?

• 6 weeks
• 8 weeks
• 12 weeks
• 14 weeks
• 24 weeks

A 65yo woman presents complaining of leaking. She is currently on lisinopril for hypertension and haloperidol for psychosis. She is also taking levothyroxine for hypothyroidism and a daily aspirin. Which of the following medications contributes to her incontinence.

• Both aspirin and levothyroxine
• Both haloperidol and lisonopril
• Only aspirin
• Only haloperidol
• Only lisinopril

A 37yo G1 presents to the emergency department with complaints of severe nausea and vomiting. TVUS reveals a viable singleton at 9 weeks of gestation. Laboratory values are obtained, and hypokalemia is noted as well as an elevated thyroxine (T4) and decreased TSH. Which of the following is MOST associated with pathologic hyperthyroidism versus transient thyrotoxicosis of pregnancy?

• Goiter
• Low triiodothyronine T3
• Molar pregnancy
• No history of prior thyroid disorder
• Self limited disorder that resolves after the first trimester

A 38yo G3P2 presents for her first prenatal visit. She has had 2 prior live births at term via cesarean delivery. The physician is trying to determine if any lab tests should be ordered in addition to standard prenatal lab tests. Which of the following would be the BEST indication for screening for thyroid disease in pregnancy?

• Weight gain
• Thyroid enlargement
• Family history of thyroid disease
• Constipation
• Fatigue