WorksheetsThyroid Disease in Pregnancy
Total questions: 12
Worksheet time: 11mins
Which of the following best describes normal thyroid function tests in the first trimester?
TSH increases, free T4 remains the same
TSH decreases, free T4 increases
TSH increases, free T4 decreases
TSH decreases, free T4 decreases
A 35-year-old G1 at 20 weeks gestation undergoes thyroid function testing. Which of the following is most consistent with a diagnosis of overt hypothyroidism?
Decrease in TSH + increase in free T4
Decrease in TSH + no change in free T4
Increase in TSH + decrease in free T4
Increase in TSH + no change in free T4
When does the fetal thyroid gland become functional?
6 weeks
8 weeks
12 weeks
14 weeks
A 28 year old G0 with history of Graves disease presents to your office for pre-conception counseling. Which of the following statements is inaccurate?
Inadequately treated hyperthyroidism has an increased risk of miscarriage and stillbirth
Treating her Graves disease will reduce her risk of maternal heart failure
She will need frequent antenatal testing to monitor her thyroid function and fetal growth
If she completes surgical or radioactive iodine treatment before pregnancy, there is less risk of neonatal thyroid disease than if she is medically managed during pregnancy
A 30 year old G1 at 20 weeks gestation underwent thyroid function testing for fatigue and edema. Her TSH is low and her free T4 levels are normal. What is the next best step for this patient?
Start levothyroxine 100 mcg daily to reduce her risk of adverse pregnancy outcomes
Perform testing for thyroid-stimulating immunoglobulin and TSH-binding inhibitory immunoglobulin
Provide reassurance that no further intervention is necessary
Initiate methimazole 10 mg BID and check a CBC
Which of the following patients should be screened for thyroid disease?
40 year old G0 with no past medical history
28 year old G3P1011 with mildly enlarged thyroid
30 year old G1 with type 1 diabetes
All of the above
A 35 year old G1 at 8 weeks gestation presented with excessive sweating, tachycardia, and tremors. She was subsequently diagnosed with hyperthyroidism based on low TSH and increased free T4. What is the next best step for this patient?
Initiate methimazole 10 mg BID and repeat TSH in 6 weeks
Initiate PTU 100 mg TID and repeat free T4 level in 6 weeks
Initiate propranolol 10 mg daily
Either (a) or (b) in addition to (c)
The same patient calls your office reporting a low-grade fever and sore throat. She is now 15 weeks pregnant. What do you advise her to do?
Stop taking the medication and come to the office to check a CBC
Continue taking the medication and come to the office to check a CBC
Continue taking the medication and monitor her symptoms at home
Call in a prescription for methimazole and instruct her to start taking this instead
A 31 year old G2P1001 at 8 weeks presents to your office for her first prenatal visit. She has a history of hypothyroidism and has not been on medications for years secondary to insurance problems. Her TSH is elevated and her free T4 is almost undetectable. What is the next best step?
Initiate levothyroxine, check a free T4 in 8 weeks
Initiate T3 supplementation, check TSH in 4 weeks
Initiate levothyroxine, check TSH in 4 weeks
Initiate both T4 and T3 supplementation, check TSH in 8 weeks
A 21 year old G1 at 16 weeks with dichorionic, diamniotic twin pregnancy and no other medical history was recently discharged 1 week ago from the hospital for hyperemesis and presents for follow-up. She feels much improved and reports complete resolution of all her symptoms. Her lab-work on admission was notable for a high serum T4 and low TSH. Her results today demonstrate her free T4 has normalized, but her TSH remains low. What is the next best step?
Observe for now, but repeat TSH in 1 week to ensure it normalizes
Perform auto-antibody testing to rule out thyroid disease
Initiate methimazole and repeat TSH in 4 weeks
Provide reassurance and schedule routine follow-up
A 25 y ear old G1 at 34 weeks with Graves disease presents with fever, tachycardia, and altered mental status. Which of the following is not indicated in management?
PTU loading and iodine administration
IV steroids
Telemetry monitoring
Immediate delivery
A 28 year old G1P1001 with no medical problems had an uncomplicated vaginal delivery 2 months ago and presents for routine follow-up. She was initially doing well, but in the last 2 days suddenly noticed significant weight loss in addition to irritability and palpitations. Thyroid function testing is abnormal. What is the next best step?
Initiation of propranolol and reassurance
Initiation of methimazole
Initiation of PTU
Referral to endocrinology
