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The most common forms of both hyper- and hypothyroidism are autoimmune: Graves disease causing hyperthyroidism and Hashimoto thyroiditis causing hypothyroidism. Hyperfunctioning ("hot") thyroid nodules are rarely malignant. Hypofunctioning ("cold") nodules >1 cm in diameter should be biopsied.

Thyroid disease is more common in women than men.


Davis A. Shahla N. A practical guide to thyroid disease in women. Female patient

(Primary care ed). 2005;30(9):38-47. Rakel RE. Essentials of family practice. Philadelphia: WB Saunders. 1993. Singer PA. Cooper DS. Levy EG. et al: Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA 1995:273:808. South-Paul JE. Maiheny SC. Lewis EL (eds.). Current diagnosis and treatment in family medicine. New York: McGraw-Hill. 2(X)4.

A 25-year-old gravida,, para, woman at 39 weeks estimated gestational age presents to the labor and delivery triage unit stating that her "bag of water has broken." She reports having had a large gush of clear fluid followed by a constant leakage of fluid from her vagina. She subsequently started having uterine contractions approximately every 4 minutes. She has had an uncomplicated prenatal course with good prenatal care since 8 weeks' gestation. Her prenatal records are available for review in the triage unit. Her first pregnancy resulted in the full-term delivery of a 7 lb 8 oz. healthy boy.

In the triage unit, she is placed on an external fetal monitor. Her blood pressure is 110/70 mm Hg. her pulse is 90 beats/min. and her temperature is 98.7°F. Her general examination is normal. Her abdomen is gravid, with a fundal height of 38 cm. The fetus has a cephalic presentation by Leopold maneuvers and an estimated fetal weight of 8 lb.

♦ What signs and tests could confirm the presence of rupture of membranes?

♦ On the fetal monitoring strip shown (Fig. 16-1), what is the approximate baseline fetal heart rate? How often is she having uterine contractions?

^ Her prenatal records reveal that she had a positive group B

streptococcus (GBS) vaginal culture at 36 weeks' gestation. What therapy should be instituted at this time?

Figure 16-1. Fetal heart rate monitoring.

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