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Endocrinology · NEET PG Preparation Medicine

A 28-year-old pregnant woman in her first trimester is evaluated for mild tachycardia and fatigue. Thyroid function tests show a TSH of 0.05 mIU/L (l…

Practice question from Endocrinology (NEET PG Preparation Medicine), with the correct answer and a step-by-step solution.

hard · MCQ · Q-C32A83

A 28-year-old pregnant woman in her first trimester is evaluated for mild tachycardia and fatigue. Thyroid function tests show a TSH of 0.05 mIU/L (low) and free T4 within the normal reference range. She has no palpable goiter, ophthalmopathy, or prior history of thyroid disease. What is the most appropriate next step in management?

  1. A.Start propylthiouracil immediately
  2. B.Check free T3 and thyroid-stimulating immunoglobulins (TSI)Correct answer
  3. C.Perform a radioactive iodine uptake scan
  4. D.Reassure and monitor thyroid function tests in 4 weeks

Solution

During the first trimester, human chorionic gonadotropin (hCG) peaks and can weakly stimulate the TSH receptor due to structural homology, causing a transient gestational thyrotoxicosis or suppressed TSH with normal free T4. However, differentiating this from true Graves disease requires measuring thyroid-stimulating immunoglobulins (TSI) or TRAb. Radioactive iodine is strictly contraindicated in pregnancy.

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