back (03.22.2007)

Low Thyroxine in Pregnancy 10/20/2006 Bishop, CA
Timothy D. Bilash, MS MS OBGYN

Case Presentation
  1. 10/06 Current Complaints
    35 y/o G4P2022
    Memory Deficits
    WtGain 15#
    Post Traumatic Stress Symptoms (Emotional, Easy to Cry)
    High Cholesterol

  2. PMH/PSH Chronology

    1. 04/00
      SAB 8-12weeks
      TFT mildly abnormal (no Tx)
    2. 04/01
      Primary Elective Cesarian @41weeks , CPD, 8#12, Apgars 8/9, Spinal
      (Labor, Macrosomia, CPD estimate 10#6)
      1. Prenatal:
        Hypothyroid (mild abnl TFT)
        Synthroid 50mcg 2/01 @30weeks
      2. Postnatal:
    3. 05/01
      Wisdom Tooth Extraction, PCN
      Spinal HA Bi-frontal s/p Cesarian, Blood Patch, "Pimply Rash"
      BP 160/97
      Synthroid 50mcg continued
    4. 06/01 (6weeks Post Partum)
      TSH<0.03, FT4 wnl
      Stop Synthroid
      Start OCP
    5. 07/01 FT4=1.03, TSH=0.61 (no meds)
    6. 08/01 Feels Well
    7. 10/01 FT4=1.06, TSH=0.68, Chol=257 (no meds)
    8. 07/02 Infrapatellar Tendonitis, Feldene
    9. 08/02 Eye erythema
    10. 01/03
      Lapsy Cholecystectomy for Gallstones
      Minimal Inflammation, Omental Adhesions to Liver Edge
      Fasting Glucose=113, PLT=195, MPV=11.2^, HCT=41
    11. 02/03
      Fall, Right Hand Sprain, R Neck Pain
    12. 03/03
      Irregular Menses x 6months
      BHCG 650, PLT 213, Enterobacter UTI, Ceftin
      Husband Sudden Military Deployment 4 days prior
      Working, 2 yr old infant
    13. 05/03
      Crying, Dizzyness, Chest Tightness, L Arm Pain, CT Head(-), MI(-)
      Stress/ Anxiety, Recent Misgivings, Daughter with Multiple Infections
      Husband Deployed to Iraq
      TSH 0.9 (0.35-5.5)
    14. 07/04
      Repeat Cesarian @40weeks, 8# female, Apgars 9/9, Spinal
      A1-Gestational Diabetes (BS 96f / 116 2hrPP controlled)
      PLT 148->120, MPV 12.3^ PP (195 on 1/03)
      h/o SABx2
      h/o Hypothyroidism ( no Synthroid x2 years )
      1. Prenatal:
        Early Severe HA
        Morning sickness
        Prometrium, Fatigue 5wks
      2. Post Partum:
        No emotional problems

  3. FH
    Stroke, MI, Thyroid Dz (Aunt x2, Thyroid Cancer Mom)
    Husband cousin Spina Bifida

  4. SH
    Husband in the Service

  5. ROS
    Forgetfulness with Pregnancies and Currently
    c/o Post Traumatic Stress Symptoms
    Weight Gain 15# since last Pregnancy
    High Cholesterol since last Pregnancy


    1. Both Breastfed
      Both are "monkies", climbing
      Both screamed all nite for 2 weeks at 5 weeks of age
      Sometimes fight, sometimes loving

    2. 1st Daughter
      5.4 years old (8#12 PCS Breastfed)
      Always 95% for growth
      Advanced Verbal Skills, Early Speech
      Catches on quickly
      Able to Distinguish "Mom" and "Dad" @ 6 months
      Great Memory
      Sang complete song in tune "Proud to Be an American" prior to 2 years
      So much energy in Preschool
      No fear, leader, "popular", "bossy mommy", climbs!
      In trouble for climbing around, advanced put at computer
      Reads all the time
      Kindergarten Teacher states the most prepared student
      Excitable about adventures, sometimes distracted
      Normal sleep, didn't sleep thru nite until 1yr age
      Potty Trained at 2.5 years
      More ear infections than other daughter

    3. 2nd Daughter
      2.3 years old (8# RCS Breastfed)
      "peanut", 25% Growth Curve
      Delay in speech 4-5 mo, now starting to chatterbox
      More timid than 1st child
      Gets Feelings hurt easily
      "Hold-me" baby, wants Mom all the time, especially if stranger talks to her
      "Happier" than 1st child
      Could not get off breastfeeding
      Never breaks the rules