THYROID DISEASES IN PREGNANCY.

TAKE OFF CASE

A.A, 32 years old, female, married, Filipino, Roman catholic, call-centre agent,
residing in Talisay, Cebu city came in due to palpitations.
Patient is not a known non-hypertensive, diabetic or asthmatic. No known food or
drug allergies, no prior surgeries or hospitalizations.
She is a non-smoker, non-alcoholic beverage drinker and denies illicit drug use.
Heredofamilial disease: Thyroid disease (maternal side).
Menarche was at 13 years of age, regular cycle, lasting for 3-4 days, soaking 3-4
pads/day, no dysmenorrhea. Coitarche was at 20 years of age with 1 male sexual
partner, (-) history of contraceptives, (-) Papsmear done.
Patient is G1P0. LMP: April 24, 2019, AOG: 38 3/7 weeks, EDC: January 31, 2020.
At 13 weeks AOG, first prenatal check up was done. Initial labs were
unremarkable. TSH: 0.05 mIU/L (low), Free T4: 2 ng/dL (high).

1. What is your diagnosis?

2. Give your basis.
3. How would you manage this patient?
At 19 weeks AOG, she presented with tachycardia, increased appetite, heat
intolerance. Repeat TSH: 0.03mIU/L(low), Free T4: 2.2ng/dL(high); thus PTU was
increased to 100mg/tab 1 tab TID.

Morning PTA, patient came in due to palpitations. (-) perceived uterine

contractions, (-) watery/bloody vaginal discharge, (+) good fetal movement.
Upon P.E, vital Signs:
T: 39.9°C (103.9F), HR: 140bpm, BP: 120/80mmHg, RR: 20cpm, 02S: 98%, Wt.:
60kg, Ht.: 157cm, BMI: 24.3kg/m2.
Skin: warm to touch with good turgor and mobility, (-) lesions
HEENT: Anicteric sclerae, pink palpebral conjunctivae, (-)exophthalmos, moist lips
and oral mucosa, (-) hyperemic tonsils
Neck: Supple, trachea at midline, thyroid gland not palpable, (-) LAD
Chest and Lungs: Symmetrical, equal chest expansion, clear breath sounds
Cardiovascular: Adynamic precordium, distinct heart sounds, tachycardic, regular
rhythm
Abdomen: gravid, FH: 33cm Estimated Fetal Weight: 3100grams
L1: breech L3: Unengaged
L2: FSP Right, FB Left L4: cephalic
IE: 1cm dilated cervix, uneffaced, posterior position, firm consistency, Station -3,
Intact BOW, Cephalic
Bishop Score: 1
Extremities: CRT<2secs, strong peripheral pulses

1. What is your working diagnosis?

2. How would you manage the patient?