Florida – Obstetrics – Pregnant Patient With TSH Of 0.10 MIU/L

On 1/9/2013, a 25-year-old female patient began her first pregnancy care at a medical center where she was examined by a physician.  The patient was in her first trimester of pregnancy.  The patient weighed 154 pounds.  The physician ordered laboratory analysis of the patient’s thyroid stimulating hormone (TSH) blood level.

On 2/1/2013, a sample of the patient’s blood was collected for TSH analysis.

On 2/5/2013, the TSH level result was reported low at 0.10 MIU/L with a first trimester reference range of 0.26-2.66 MIU/L.

On 2/7/2013, the patient returned to the medical center for obstetric follow-up and complained that she could not hold down food.  The patient weighed 150 pounds.  An obstetrician evaluated the patient.

The medical records document that on 1/22/2013 the patient had been prescribed Zofran 8 mg, with instructions to take one tablet every eight hours for fifteen days.  Zofran is the brand name for ondansetron, an anti-emetic used during pregnancy for treatment of morning sickness, nausea, and vomiting.

On 2/7/2013, the medical records document that the patient would be traveling for three months.

The obstetrician prescribed Phenergan suppositories to the patient.  Phenergan is the brand name for promethazine, an antihistamine with antiemetic properties used during pregnancy to treat morning sickness, nausea, and vomiting.

On 2/7/2013, the medical centers records documented the patient’s low TSH test result from 2/1/2013.  The obstetrician failed to recognize the significance of the patient’s complaints and TSH test results.  The obstetrician did not order additional tests to evaluate the patient’s low TSH at any time during his care of the patient.  The obstetrician did not inform the patient of her low TSH result at any time during his care of the patient.  The obstetrician instructed the patient to return as needed.  The obstetrician did not plan close follow-up of the patient’s complaints of weight loss.  The obstetrician did not refer the patient to a specialist for evaluation of her low TSH.

Following her 2/7/2013 visit with the obstetrician, the patient was diagnosed with and began treatment for hyperthyroidism while visiting Iran.

The Board judged the obstetrician’s conduct to be below the minimum standard of competence given his failure to recognize the significance of the patient’s symptoms and test results, advise the patient of her low TSH, order laboratory analysis of T3 and T4 blood levels, plan close monitoring of the patient’s symptoms and thyroid hormone levels to prevent a delay in diagnosis of hyperthyroidism, diagnose the patient’s hyperthyroidism, or refer the patient to an endocrinologist for evaluation.

The Board ordered that the obstetrician pay a fine of $5,000 against his license and pay reimbursement costs for the case for a minimum of $3,076.77 and not to exceed $5,076.77.  The Board also ordered that the obstetrician complete a medical records course in “Quality Medical Record Keeping for Health Care Professionals” and complete five hours of continuing medical education in “Risk Management.”  The Board ordered that the obstetrician complete one hour lecture/seminar on prenatal screening, including screening for hyperthyroidism.

State: Florida


Date: February 2015


Specialty: Obstetrics, Endocrinology


Symptom: Weight Loss


Diagnosis: Endocrine Disease


Medical Error: Diagnostic error, Referral failure to hospital or specialist, Failure of communication with patient or patient relations, Failure to follow up, Failure to properly monitor patient


Significant Outcome: N/A


Case Rating: 3


Link to Original Case File: Download PDF



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