Hypothyroidism and fertility — SCE Endocrinology MCQ

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HardThyroidHypothyroidism and fertilitySCE Endocrinology

A 32-year-old planning pregnancy has two TSH results around 4.8 mIU/L, free T4 at the lower end of normal and positive thyroid peroxidase antibodies. She is clinically well. What is the best next step?

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Correct answer: D — Preconception levothyroxine discussion with early pregnancy thyroid monitoring

The best answer is “Preconception levothyroxine discussion with early pregnancy thyroid monitoring”. Persistent subclinical hypothyroidism with thyroid autoimmunity in a person planning pregnancy warrants an individual preconception treatment decision and close monitoring because thyroid requirements change early in gestation. “Start carbimazole to lower TSH before conception” is less appropriate because carbimazole treats hyperthyroidism and would worsen this biochemical state “Give radioiodine and advise conception the following month” is less appropriate because radioiodine is inappropriate for hypothyroidism and requires pregnancy avoidance “Reassure and omit thyroid testing once pregnancy is confirmed” is less appropriate because thyroid function should be checked early and followed during pregnancy when disease or treatment is present “Use propranolol as thyroid hormone replacement throughout pregnancy” is less appropriate because a beta blocker cannot replace deficient thyroid hormone

Reference: NICE NG145: Thyroid disease — assessment and management. https://www.nice.org.uk/guidance/ng145/chapter/Recommendations NICE NG3: Diabetes in pregnancy — recommendations. https://www.nice.org.uk/guidance/ng3/chapter/recommendations