In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?

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A 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves’ disease.

On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.

Investigations:

serum sodium143 mmol/L (137C144)

serum potassium4.4 mmol/L (3.5C4.9)

serum creatinine105 µmol/L (60C110)

serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4C5.0)

serum free T424.0 pmol/L (10.0C22.0)

serum free T311.0 pmol/L (3.0C7.0)

A TSH receptor antibody concentration was awaited.

In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?
A . carbimazole
B . labetalol
C . observation
D . propranolol
E . propylthiouracil

Answer: C

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