ECE2020 ePoster Presentations Thyroid (122 abstracts)
Low TSH level and twin pregnancy. A case report
Marjeta Kermaj 1 , Thanas Fureraj 1 , Violeta Hoxha 1 , Klodiana Poshi 1 , Dorina Ylli 1 , Besa Hyka 1 , Sara Zavalani 1 , Irsa Zaimi 2 , Klotilda Resuli 3 , Adela Shkurti 4 & Agron Ylli 1
1UHC ‘Mother Tereza’, Endocrinology, Tirana, Albania; 2Regional Hospital Fier, Endocrinology, Fier, Albania; 3Regional Hospital Vlora, Endocrinology, Vlora, Albania; 4Hospital ‘Vila Maria’, Endocrinology, Tirana, Albania
Introduction: Thyroid physiology changes during pregnancy so the use of pregnancy-specific reference ranges for TSH and FT4 in order to adequately diagnose gestational thyroid disease is necessary. According to literature, in twin pregnancy, TSH can be in low levels during first trimester due to a much higher and more sustained peak of hCG (TSH-like activity of human chorionic gonadotropin) but it will be normalized at the end of the second trimester or within 22 weeks. Hyperemesis gravidarum (HG) is reported to occur in 0.3% to 1.0% of pregnancies.
Case report: Our patient, Caucasian female, 42 years old, pregnant 22 weeks, hospitalized at maternity hospital for being under close medical care. Before current pregnancy she had had 5 abortions (2 natural pregnancies and 3 pregnancies under IVF treatment). The current pregnancy has also been assisted by in vitro fertilization techniques. During the first 16 weeks of pregnancy she had been having hyperemesis gravidarum. In following she was without nausea and vomitus. She complained anorexia and fatigue. Familiar history and her life history not related to thyroid disease. She had normal weight body, mild hands tremor, and palpitations with a pulse rate of 100 beats per minute. Laboratory examinations reveled a TSH 0.006 IU/l. She was evaluated for thyroid diseases. FT4 = 14.2 pg/ml (7–18), FT3 = 3.9 pg/ml (2–4.25), T4 11.2 µg/ml (5.1–14.1) R-TSH ac 0.37UI/ml (<1). Thyroid ultrasound resulted normal. She was followed by repeating TSH, T3, T4 every month until delivering. It was noted that TSH stood in low levels (0.001 Ulu/ml) until delivering but FT4 and T4 in normal value. She was very stressed during her pregnancy because of fear of losing the pregnancy again. She underwent section cesarean at 35 weeks and she gave birth a healthy male child 2000 gr and a hypotrophy female child 1400 gr.
Conclusion: Every medical physician who takes care of a twin pregnancy, must recognize that a TSH level that keeps standing quite low (more than 22 weeks of pregnancy), does not always correspond with thyroid dysfunction and may be caused by other conditions such as hyperemesis gravidarum, higher level of hCG during twin gestation than pregnancy with a baby and maternal chronic stress. We thought that a combination of all these conditions have kept quite low TSH level until the end of pregnancy.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more