A 23-year-old primigravida presents to her physician’s office at 12 weeks gestation complaining of increased sweating and palpitations for the last week. She does not have edema or dyspnea, and had no pre-existing illnesses. The patient says that the symptoms started a few days after several episodes of vomiting. She managed the vomiting at home and yesterday the vomiting stopped, but the symptoms she presents with are persistent. The pre-pregnancy weight was 54 kg (119 lb). The current weight is 55 kg (121 lb). The vital signs are as follows: blood pressure 130/85 mm Hg, heart rate 113/min, respiratory rate 15/min, and temperature 37.0℃ (98.6℉). The physical examination is significant for diaphoresis, an irregular heartbeat, and a fine resting tremor of the hands. The neck is not enlarged and the thyroid gland is not palpable. The ECG shows sinus tachyarrhythmia. The thyroid panel is as follows: Thyroid stimulating hormone (TSH) < 0.1 mU/L Total T4 178 nmol/L Free T4 31 pmol/L Which of the following is indicated?
ARecommend iodine radioablation
BSchedule a subtotal thyroidectomy
CPrescribe methimazole
DManage with propylthiouracil
EEnsure proper hydration and prescribe a beta-blocker
A 28-year-old gravida-2-para-1 at 12 weeks gestation presents for a prenatal visit. Over the past week, she has felt increasingly tired, even after waking up in the morning. She is vegan and avoids all animal products. She was diagnosed with Graves’ disease 6 months ago. Before conception, methimazole was switched to propylthiouracil (PTU). Other medications include folic acid and a multivitamin. The vital signs include: temperature 37.1℃ (98.8℉), pulse 72/min, respiratory rate 12/min, and blood pressure 110/75 mm Hg. The conjunctivae and nail beds are pale. Petechiae are present over the distal lower extremities. The pelvic examination reveals a uterus consistent in size with a 12-week gestation. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 9.0 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 4,000/mm3 Segmented neutrophils 55% Lymphocytes 40% Platelet count 110,000/mm3 Serum Thyroid-stimulating hormone 0.1 μU/mL Thyroxine (T-4) 8 μg/dL Lactate dehydrogenase 60 U/L Total bilirubin 0.5 mg/dL Iron 100 μg/dL Ferritin 110 ng/mL Total iron-binding capacity 250 μg/dL Which of the following best explains these findings?
AExcess antithyroid medication
BDrug-induced marrow failure
CVitamin B12 deficiency
DHemodilution of pregnancy
EAutoimmune hemolysis
A 28-year-old G1P0 woman comes to the emergency department complaining that her water just broke. She reports irregular prenatal care due to her erratic schedule. She is also unsure of her gestational age but claims that her belly began to show shortly after she received her thyroidectomy for her Graves disease about 9 months ago. She denies any known fevers, chills, abnormal vaginal discharge/bleeding, or sexually transmitted infections. She develops frequent and regular contractions and subsequently goes into active labor. A fetus was later vaginally delivered with a fetal heart rate of 180 bpm. A neonatal physical examination demonstrates a lack of a sagittal cranial suture and an APGAR score of 8 and 8, at 1 and 5 minutes respectively. What findings would you expect in the baby?
APericardial effusion
BGroup B streptococcus in blood
CLow hemoglobin
DHigh levels of free T4 and total T3
EHigh thyroid-stimulating hormone
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