New SBAs and EMQs on Thyroid Disorder in Pregnancy

For each scenario described below, choose the most appropriate diagnosis:

• A 26-year-old primigravida presents to the antenatal assessment unit at 9 weeks’ gestation with severe nausea and vomiting for the past two weeks. She reports difficulty keeping food down and has lost 3 kg in weight. She has no significant past medical history. On examination she appears dehydrated. Her pulse is 104 bpm and blood pressure 110/70 mmHg. There is no goitre, no thyroid eye signs, and the thyroid gland is not tender.

  Blood investigations show:

  • TSH: suppressed below the pregnancy-specific reference range
  • Free T4: mildly elevated above the pregnancy-specific reference range
  • Free T3: within the normal pregnancy-specific reference range
  • TSH receptor antibodies (TRAb): negative
  • Thyroid peroxidase antibody (TPOAb): negative

For each scenario described below, choose the most appropriate diagnosis:

• A 34-year-old primigravida attends her booking visit at 10 weeks’ gestation. She feels well and has no significant past medical history. She reports mild fatigue but attributes this to early pregnancy. There is no personal or family history of thyroid disease. On examination, her pulse is 78 bpm, blood pressure 112/68 mmHg, and BMI 27 kg/m². There is no goitre and no clinical features of hypothyroidism.

  Routine thyroid function tests performed due to a history of previous infertility treatment show:

  • TSH: within the pregnancy-specific reference range
  • Free T4: below the pregnancy-specific reference range
  • TSH receptor antibodies (TRAb): negative
  • Thyroid peroxidase antibodies (TPOAb): negative