Endocrine Abstracts

Introduction: Hypothyroidism is the most common endocrine dysfunction during pregnancy. In pregnancy, hypothyroidism is most often due to chronic autoimmune thyroiditis (Hashimoto’s disease) The consequences of hypothyroidism vary depending on the time of onset of hypothyroidism during pregnancy and the etiology retroplacental hematoma is a serious complication of hypothyroidism We report the case of a patient with in utero fetal death on retroplacental hematoma complicated by hypothyroidism

Observation: questioning The patient is 35 years old. History: followed for hypothyroidism on levothyrox 150 mg/d Admitted for heavy metrorrhagia with obstetrical ultrasound has objectified: fetal death in utero with evidence of a retroplacental hematoma On clinical examination Patient Conscious, pale and discolored conjunctivae Blood pressure=130/80 mmhg; heart rate =69bpm; Non-palpable thyroid The rest of the exam was unremarkable. On the balance sheet: Blood count: hemoglobin=6.9; White blood cells=9110; platelets =300000 TSH=77 mui/l; Cervical ultrasound: atrophic thyroid gland Therapeutic care The patient was put on levothyrox: 175 mg/d A cardiovascular evaluation has been requested

Discussion: -Retroplacental hematoma is a polycausal disease with etiological factors (vascular, age, environmental) -Publications suggest that dysthyroidism and more particularly hypothyroidism may be a risk factor for Retroplacental hematoma According to a study published in 2013; RPH in hypothyroidism can be explained by several factors: thyroid hormones play a very important role in Placentation: 11-16 amenorhea week ( defined as Invasion of trophoblasts into the maternal decidua and the spiral artery) In Hypothyroidism: insufficient trophoblastic invasion responsible for ischemia and placental abruption hypothyroidism is associated with thrombo-embolic and hemorrhagic phenomena which is explained by the alteration of the coagulation system – fibrinolysis the presence of anti tpo ac is more likely associated with other immune diseases and alteration of the immune system another study published in 2020 did not find a significant link between hypothyroidism and RPH

Conclusion: This observation underlines the importance of determining the place of this risk factor within the various FDRs of RPH already known and the need to set up preventive strategies, in particular when the usually effective treatment of hypothyroidism is lacking.