Thyroid Case 1

A 28 year-old Caucasian female with a history of Graves' disease status post robotic thyroidectomy two years prior presents at 24 weeks gestation for management of hypothyroidism. She is taking levothyroxine 125 mg daily since her surgery, and her hypothyroidism is well controlled. She complains of mild fatigue, but otherwise feels well. Her past medical history is otherwise significant only for seasonal allergies. She does not have a family history of autoimmune thyroid disease. She works in the fire department as a clerk. Her only medication is levothyroxine, and she has no allergies. Her review of systems (ROS) is negative apart from her fatigue.

Her pulse rate is 85 beats per minute with a blood pressure of 105/75 mm Hg. Physical exam is normal without lid lag, stare, proptosis, or periorbital edema. Her neck is supple with an empty thyroid bed. Her lungs are clear, and she has normal heart sounds (S1, S2) with no murmurs. Her abdomen is gravid and nontender. The rest of the physical exam is unremarkable. Her laboratory test results show normocytic normochromic anemia and a normal comprehensive metabolic panel. The thyroid function test reveals a thyroid-stimulating hormone (TSH) level of 12.0 mIU/L (reference range second trimester, 0.2 to 3 mIU/L) and a decreased free thyroxine (T4) level of 0.2 ng/dL (reference range, 0.8-1.8 ng/dL).

Question 1

  The patient and/or the fetus are at risk of the following complications except?

A. Preeclampsia
B. Preterm delivery
C. Placenta accreta
D. Low birth weight
E. Neuropsychological and cognitive impairment
Incorrect!
Correct!
Correct Answer
C. Placenta accreta

Overt hypothyroidism has been associated with increased risk of many complications, including miscarriage, preeclampsia (option A), gestational hypertension, placental abruption, preterm delivery (option B), low birth weight (option D), increased risk of cesarean section, perinatal morbidity and mortality, neuropsychological and cognitive impairment (option E), and postpartum hemorrhage.Placenta accreta (option C) occurs when all or a section of the placenta attaches abnormally to the myometrium. Risk factors for placenta accreta include placenta-previa with a concurrent uterine scar, maternal age, multiparity, other prior uterine surgery, uterine irradiation, endometrial ablation, hypertension, and smoking.In overt primary hypothyroidism, TSH levels are elevated (usually >10 mIU/L) with low free T4 concentrations. Subclinical hypothyroidism is characterized by elevated TSH and normal free T4 levels.

Overt hypothyroidism has been associated with increased risk of many complications, including miscarriage, preeclampsia (option A), gestational hypertension, placental abruption, preterm delivery (option B), low birth weight (option D), increased risk of cesarean section, perinatal morbidity and mortality, neuropsychological and cognitive impairment (option E), and postpartum hemorrhage.Placenta accreta (option C) occurs when all or a section of the placenta attaches abnormally to the myometrium. Risk factors for placenta accreta include placenta-previa with a concurrent uterine scar, maternal age, multiparity, other prior uterine surgery, uterine irradiation, endometrial ablation, hypertension, and smoking.In overt primary hypothyroidism, TSH levels are elevated (usually >10 mIU/L) with low free T4 concentrations. Subclinical hypothyroidism is characterized by elevated TSH and normal free T4 levels.