Date:
Patient:
MRN:
Clincian: (Obstetrician, Endocrinologist)
Reason for Visit:
Follow-up for gestational transient thyrotoxicosis (GTT)
Evaluation of thyroid function tests and clinical symptoms
Discussion of treatment plan and pregnancy monitoring
History of Present Illness:
Briefly describe the patient’s current status:
Gestational age
Presence and severity of any symptoms suggestive of hyperthyroidism (weight loss, anxiety, heat intolerance, palpitations) – symptoms may be subtle or absent.
Date of initial GTT diagnosis and any previous treatment interventions
Past Medical History:
Underlying thyroid conditions (pre-existing Graves’ disease)
Other medical conditions relevant to pregnancy
Family History:
Family history of thyroid disorders
Social History:
Not typically relevant for GTT
Physical Exam:
Vital Signs: May be normal or abnormal depending on the severity of hyperthyroidism (tachycardia – fast heart rate).
Thyroid exam: Thyroid gland may be non-palpable (not felt) or slightly enlarged.
Labs:
Thyroid function tests (TFTs):
Free T4 (fT4) levels may be elevated within the normal reference range for pregnancy or mildly elevated above the range.
Thyroid Stimulating Hormone (TSH) levels are typically suppressed.
Consider mentioning other labs ordered as needed (anti-TPO antibodies to differentiate GTT from Graves’ disease).
Imaging:
Ultrasound: May be used to assess fetal growth and development.
Imaging of the thyroid gland is not routinely performed for GTT.
Assessment:
Summarize the diagnosis and current status:
Confirmation of GTT diagnosis based on clinical presentation, gestational age, and laboratory findings.
Severity of hyperthyroidism based on TFT results and symptoms.
Plan:
Outline the treatment plan based on the assessment:
Reassurance and monitoring: In many cases, close monitoring of maternal and fetal well-being may be sufficient, especially for mild cases.
Antithyroid medications: Beta-blockers may be used to control some symptoms like heart palpitations. Anti-thyroid medications (propylthiouracil) may be considered in severe cases or if symptoms are not well-controlled.
Frequent monitoring of TFTs is crucial to ensure proper medication dosing and prevent overtreatment (hypothyroidism).
Prognosis:
Briefly discuss the prognosis. GTT typically resolves spontaneously after the first trimester.
Emphasize the importance of ongoing monitoring to ensure both maternal and fetal well-being.
Education:
Document any education provided to the patient regarding:
The nature of GTT and its course during pregnancy
The importance of following up with appointments and adhering to the treatment plan
Warning signs and symptoms that may require urgent evaluation (worsening symptoms, fetal distress)
The potential risks of untreated hyperthyroidism on pregnancy
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about medication use during pregnancy or the potential impact on the fetus.
Consider mentioning the importance of maintaining a healthy diet and adequate hydration.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with an obstetrician and endocrinologist for diagnosis, treatment recommendations, and prognosis during pregnancy