New thyrotoxicosis in pregnancy — diagnostic and management station

Diagnostic and management station on new thyrotoxicosis in pregnancy. Tests the candidate on distinguishing Graves from gestational transient thyrotoxicosis, the antithyroid drug strategy by trimester, fetal surveillance, and communication. Includes assessor key and marking domains.

Prompt

A 28-year-old G1P0 at 16 weeks gestation presents to the maternity assessment unit with a two-week history of palpitations, weight loss of 4 kg despite good appetite, heat intolerance and tremor. She has been vomiting intermittently. Observations: HR 122 bpm, BP 142/68 mmHg, RR 22, oxygen saturation 99 percent on room air, afebrile. She has a fine tremor, a diffusely enlarged smooth thyroid with a soft bruit, and lid lag. TFTs taken in clinic: TSH under 0.05 mIU per L, free T4 38 pmol per L.

Station brief

Format. Diagnostic and management station, approximately 12 minutes. You are the obstetric registrar on the maternity assessment unit. A midwife and an endocrinology registrar are available on call. The assessor will run the clock and feed you new information. ^[1]

Candidate instruction. Lead the assessment and management of new thyrotoxicosis in pregnancy. Verbalise your differential, your investigations, your drug orders with doses, your escalation triggers, and your communication with the patient and team. ^[1]^[2]

References3Show

[1]Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum Thyroid, 2017.PMID 28056690
[2]King JR, Lachica R, Lee RH, Montoro M, Mestman J Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review Obstet Gynecol Surv, 2016.PMID 27901552
[5]Laurberg P, Andersen SL Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk? Eur J Endocrinol, 2014.PMID 24662319

New thyrotoxicosis in pregnancy — diagnostic and management station

Station brief

References3Show

[1]Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum Thyroid, 2017.PMID 28056690
[2]King JR, Lachica R, Lee RH, Montoro M, Mestman J Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review Obstet Gynecol Surv, 2016.PMID 27901552
[5]Laurberg P, Andersen SL Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk? Eur J Endocrinol, 2014.PMID 24662319