A 27-year-old woman presented with severely symptomatic Graves and ophthalmopathy (FT4 49.1; TSI 53). Despite 60 mg carbimazole and 240 mg propranolol she required admission to control her symptoms and thyroid function, changing to propylthiouracil 800 mg daily with propranolol (FT4 19.9). Whilst considering thyroidectomy a 6-week pregnancy was confirmed. She relapsed (? compliance) and was admitted at 14 weeks with hyperemesis gravidarum (FT4 >77.2), which responded to antiemetics, intravenous fluids and 20 mg prednisolone. She was readmitted at 17 weeks to prepare for thyroidectomy, receiving Lugols iodine, propylthiouracil, propranolol and withdrawal of prednisolone. She underwent partial thyroidectomy at 19 weeks (FT4 8.0) and was managed post-operatively on HDU without sequelae, with thyroxine 100 mcg being commenced postoperatively.
At 27 weeks propylthiouracil 100 mg was recommended for foetal protection because of persisting high TSI (TSI 44.0; FT4 17.1; TSH 0.1). At 32 weeks she developed premature labour, an antepartum haemorrhage with an abnormal CTG and underwent an emergency caesarean section. A female baby weighing 1.545 kg was delivered without evidence of foetal thyrotoxicosis. Baby remains well and mother euthyroid.
This case demonstrates a series of problems and management issues in severe thyrotoxicosis and pregnancy.
01 - 05 Apr 2006
European Society of Endocrinology