A 40-year-old woman, 6 weeks pregnant, presents with diarrhea, heat intolerance, and palpitation. She has a family history of thyroid disease and the following lab results: Heart... A 40-year-old woman, 6 weeks pregnant, presents with diarrhea, heat intolerance, and palpitation. She has a family history of thyroid disease and the following lab results: Heart rate: 90/min Respiratory rate: 18/min Temperature: 37.2 °C TSH: 0.001 yU/mL (Normal: 0.4 - 5.0 yU/mL) Free T4: 45 pmol/L (Normal: 8.5 - 15.2 pmol/L) TSH receptor antibodies: Positive Which is the most appropriate initial management? A. Propranolol B. Carbimazole C. Propylthiouracil D. Total thyroidectomy Read more

Understand the Problem

The question describes a pregnant woman with symptoms and lab results indicative of hyperthyroidism, likely Graves' disease. We need to determine the most appropriate initial management option, considering her pregnancy and the need to control her thyroid hormone levels.

More Information

Given the patient's symptoms (diarrhea, heat intolerance, palpitations), lab results (suppressed TSH, elevated free T4, positive TSH receptor antibodies), and family history, she likely has Graves' disease, which is the most common cause of hyperthyroidism. During pregnancy, Propylthiouracil is usually preferred in the first trimester, but Propranolol can be used to manage the adrenergic symptoms (palpitations, tremor, anxiety) while further evaluation and definitive treatment are arranged.

Tips

A common mistake is to immediately choose definitive treatment (Carbimazole or Propylthiouracil) without addressing the immediate symptoms. Propranolol is used for symptomatic control.

Sources

• 37-Year-Old Woman With Palpitations and Fatigue - PMC - pmc.ncbi.nlm.nih.gov