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Hypothyroidism in pregnancy — SCE Endocrinology MCQ

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HardThyroidHypothyroidism in pregnancySCE Endocrinology

A 29-year-old woman with thyroid peroxidase antibody-positive hypothyroidism is 8 weeks pregnant. She takes levothyroxine 100 micrograms daily. TSH is 6.8 mU/L and free T4 is low-normal. What is the most appropriate management?

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Correct answer: E — Increase levothyroxine dose and recheck TSH in 4 weeks

Increase levothyroxine dose and recheck TSH in 4 weeks is best because pregnancy increases levothyroxine requirements and raised early-pregnancy TSH should be corrected promptly. The alternatives are less appropriate because stopping replacement risks fetal and maternal hypothyroidism; carbimazole treats hyperthyroidism; waiting delays treatment; routine liothyronine is not recommended. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions