Correct!
1. Elevated hCG is anticipated in the first trimester
hCG is produced by the placenta and elevated during the first trimester of pregnancy and declines over the next two trimesters. The most commonly accepted theory of hyperemesis gravidarum suggests that these high levels of hCG account for the nausea and vomiting and the decline in these complaints in the second and third trimester (1). hCG is often markedly elevated with choriocarcinoma although it can be only mildly elevated. Free T4 does increase in pregnancy by up to 50% (2). However, the T4 is elevated to a much higher level than expected. Our patient’s thyroid stimulating hormone (TSH) was <0.01 (normal: 0.2–3.0 mIU/L). Thyroid ultrasound imaging showed no nodules or goiter. Thyroid stimulating immunoglobulins (TSI) was <89% of baseline (normal: <140%). A Burch-Wartofsky score of >45 was calculated and a presumptive diagnosis of gestational transient thyrotoxicosis was made (3). Our patient was admitted to the intensive care unit, treated with IV fluids and electrolytes and consultation by hepatology and endocrine.
What additional therapy should be given for her thyrotoxicosis? (Click on the correct answer to be directed to the sixth and final page)