Question of the Week # 420

420) A 34-year-old woman with past medical history of Hypothyroidism presents to the outpatient clinic for follow-up visit. She delivered a health male baby about one week ago and has been breast feeding without any issues. She has no complaints. During the pregnancy she required increase of her levothyroxine dose to 0.175 mcg from  her usual pre-pregnancy dose of 0.125mcg. Her TSH level about 2 weeks ago was 2.0µu/ml. She denies any cold or heat intolerance, weakness or constipation. On physical examination, vitals are stable. There is no goiter. Deep tendon reflexes are normal.  Which of the following is the most appropriate management at this time?

A) Decrease Levothyroxine to pre-pregnancy dose and recheck TSH in 6 weeks

B) Repeat TSH in 6 weeks before dose adjustment

C) Increase Levothyroxine and repeat TSH in 6 weeks

D) Repeat TSH now

E) Obatin Thyroid Peroxidase antibodies

10 Responses

  1. A

  2. d

  3. a

  4. A) Decrease Levothyroxine to pre-pregnancy dose and recheck TSH in 6 weeks

  5. A-decrease to pre pregnancy dose & recheck in 6 weeks.

  6. B

  7. d

  8. D-
    She has no clinical symptoms, repeat tsh and f/u in 1 week and adjust

  9. ans A
    you don’t have to wait to reduce the dose .

    found a very useful guidelines

    http://www.cks.nhs.uk/hypothyroidism/management/scenario_preconception_or_pregnant#-483803

    • good one nut….

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