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Pharmacological Management of Thyroid Disorder in a Pregnant Patient
Leonard Wartofsky, MD, MACP
Chairman, Department of Medicine
Washington Hospital Center
Washington, DC
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A 24-year-old female is referred for evaluation by her obstetrician/gynecologist who has seen her for infertility. She has a history of Hashimoto thyroiditis that was diagnosed at age 15, and she is taking levothyroxine
(LT4) in a dose of 0.75 µg/d. She has a small goiter, but her history and physical exam are otherwise unremarkable.
Upon examination, the patient's hematocrit value was 36%, and she had a thyroid-stimulating hormone (TSH) value of 4.2
mIU/L(reference range, 0.3-5.5). Her free
T4 level was 0.90 µg/dL, and her total T4 (TT4) level was 7.9
µg/dL(reference ranges, 0.80-1.90 and 5-12, respectively
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