Question of the Week

For September 29, 2015

A 24-year-old, gravida 3, para 2 woman at 18 weeks’ estimated gestation reports palpitations and is found to have a thyroid-stimulating hormone level of 5.1 μU/mL (trimester-specific reference range, 0.2–3.0). She has no family history of thyroid disease.

Physical examination reveals no thyromegaly or nodules. Her reflexes are 2+ throughout. She currently feels well, and her palpitations resolve without any treatment. Her fetus is active.

What is the most appropriate next step for this patient?

Initiate treatment with levothyroxine 25 μg daily
Measure the free thyroxine level
Initiate treatment with iodine 220 μg daily
Repeat thyroid-stimulating hormone testing in 4 to 6 weeks
Measure total thyroxine and total triiodothyronine