A 26-Year-Old Woman Calls the Office with a Question About

question 949

Multiple Choice

A 26-year-old woman calls the office with a question about management of hypothyroidism during pregnancy.  The patient is not pregnant but wishes to become pregnant soon.  She has a history of hypothyroidism for several years and has been on a stable dose of levothyroxine.  TSH checked 3 months ago was 2.0 µU/mL.  The patient currently has mild fatigue but is otherwise asymptomatic.  Family history is notable for primary hypothyroidism in her mother, who is doing well on a regimen of liothyronine (T₃) and levothyroxine (T₄) .  Which of the following is the most appropriate recommendation for this patient?

• A)Continue the current levothyroxine dose through pregnancy
• B)Decrease the levothyroxine dose when the patient becomes pregnant
• C)Increase the levothyroxine dose prior to pregnancy
• D)Increase the levothyroxine dose when the patient becomes pregnant
• E)Switch to combination treatment with liothyronine and levothyroxine

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