Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2021) 73 AEP612 | DOI: 10.1530/endoabs.73.AEP612

1CHU Larrey, Toulouse, Endocrinology, Toulouse, France; 2CHU Purpan, Biology, Toulouse, France; 3Centre Hospitalier Lyon, Biology, Lyon, France; 4CH Saint Pierre, Endocrinology, Bruxelles, Belgium


Introduction

During pregnancy, women with Graves’ disease are at risk of maternal and fetal hyperthyroidism caused by stimulating TSH receptor antibody. Here we report the unusual case of a woman with recurrent Graves’ disease who developed central hypothyroidism transiently during pregnancy.

Case report and results

A 26-year-old woman was treated by antithyroid drug for a third episode of hyperthyroidism due to Graves’ disease. At the beginning of her second pregnancy, cervical palpation showed a large vascular goiter. Thiamazole treatment was stopped in the first week of gestation. During the 3rd month, hormonal monitoring revealed central hypothyroidism: TSH = 1 mU/l (0.27–4.3), fT4 = 0.67 ng/dl (0.81–1.32), fT3 = 2.37 ng/l (2.47–4.1), in presence of anti-TSH receptor antibodies (3.5 UI/l) with stimulating activity (+ 285%) and elevated βHCG levels (153 656 UI/l). During the second half of gestation, substitutive levothyroxine treatment restored an euthyroid state. Furthermore, anti-TSH receptor antibodies titers decreased progressively and were undetectable at the end of the second trimester. The woman gave birth to a healthy euthyroid baby girl (3.2 kg) without goiter. During the postpartum period, she breastfed normally. Her anterior pituitary function was investigated and shown to be normal: spontaneous menstrual periods, anterior pituitary hormones within normal range and normal pituitary IRM at 6-month post-partum. During post-partum follow-up, levothyroxine treatment was progressively decreased and the patient eventually developed ’classical’ recurrence of Graves’ disease with thyrotoxicosis 8 months after delivery.

Conclusion

We report the first case of transient central hypothyroidism during pregnancy in a woman with recurrent episodes of Graves’ disease. Despite the presence of anti-TSH receptor antibodies with stimulating activity detectable during the first two trimesters of pregnancy, we suggest, as a unifying hypothesis to explain this highly unusual clinical and biological pattern, that this woman secreted a variant hCG molecule that binds both to the TSH receptor on follicular thyroid cells and on the folliculo-stellate cells of the anterior pituitary with inhibiting activity resulting in central hypothyroidism.

Volume 73

European Congress of Endocrinology 2021

Online
22 May 2021 - 26 May 2021

European Society of Endocrinology 

Browse other volumes

Article tools

My recent searches

No recent searches.