Severe Maternal Morbidity and Near Miss Mortality - A Case Report of an Adolescent with a Thyroid Storm (original) (raw)
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Thyroid storm in the second stage of labour: a case report
2021
A thyroid storm (or thyroid crisis) is an emergency in endocrinology. It is a form of complication of hyperthyroidism that can be life-threatening. Inadequate control of hyperthyroidism in pregnancy could develop into thyroid storm, especially in the peripartum period. We present a woman came in the second stage of labour, with thyroid storm, superimposed pre-eclampsia, acute lung oedema and impending respiratory failure. Treatment for thyroid storm, pre-eclampsia protocol and corticosteroid was delivered. The baby was born uneventfully, while the mother was discharged after 5 days of hospitalisation. Delivery is an important precipitant in the development of thyroid storm in uncontrolled hyperthyroidism in pregnancy. Although very rare, it can cause severe consequences. Diagnosis and treatment guidelines for thyroid storm were available and should be done aggressively and immediately. Uncontrolled hyperthyroidism should be prevented by adequate control in thyroid hormone levels, es...
Diagnosis and Comprehensive Management of Thyroid Storm in Pregnancy: A Case Report
Biomedical and Pharmacology Journal, 2018
Thyroid crisis is an emergency in Endocrinology which is characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause. This condition is rare serious complication, affect about 1-2% of patients with hyperthyroidism. Unrecognized and untreated thyroid storm causing life threatening condition. Management of thyroid storm in pregnancy is aimed to reduce the synthesis and secretion of thyroid hormone and pregnancy management. Explain about optimal diagnostic and treatment strategies of pregnancy with thyroid storm. A 28 years woman admitted to Obstetrics Emergency Room, third pregnancy with 36 weeks 2 weeks gestation was complained of shortness of breath since 3 days ago. History of hyperthyroid since 1 year ago, often palpitate, sweating and tremor. History of consumption PTU 3x100 mg oral but lack of obey. History of hypertension since 27 weeks gestation. Physical examination found that blood pressure was 170/110 mmHg, pulse rate 13...
Neonatal Graves-Basedow disease due to long-standing TRAb persistence following total thyroidectomy
Journal of Translational Medicine and Research, 2015
Background: Neonatal Graves-Basedow disease is a rare and transient complication due to mother's Basedow disease, occurring extremely rare due to Hashimoto thyroiditis or as a persistent hyperthyroidism due to activating mutations of the Thyroid-Stimulating Hormone (TSH) receptor. It may cause goiter and hyperthyroidism in the neonate, prematurity or fetal death, in some cases needing therapy and pre-conception counseling. Case presentation: We report the case of a premature newborn from a mother who underwent total thyroidectomy for Basedow disease 7 years before conception, euthyroid before and during pregnancy on levothyroxine therapy. The mother was not checked for antibodies against thyroid stimulating hormone (TSH) receptor (TRAb) persistence before pregnancy. Despite response to anti-thyroid therapy, hyperthyroidism, cardiac congenital disease and prematurity complicated the evolutionof the newborn, leading to death in the 27th day of life. Conclusion: The case is interesting due to long-standing persistence of TRAb after total thyroidectomy and the severe impact of hyperthyroidism in the fetus and neonate, despite low circulating levels of TRAb in mother which point out that other microenvironmental and/or genetic factors might be involved in the dramatic demise of the neonate. Fertile-aged women should be counseled.
Graves' disease in pregnancy: Prospective evaluation of a selective invasive treatment protocol
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: Graves' disease in pregnancy carries a risk of fetal thyrotoxicosis from the transplacental transfer of thyroid-stimulating antibodies or fetal hypothyroidism from transplacental transfer of antithyroid drugs and thyroid-blocking antibodies. STUDY DESIGN: From 1991 through 2002, all pregnant women with Graves' disease underwent follow-up evaluations that included serial thyroid-stimulating antibody level, thyroid function, and ultrasound examinations. Umbilical blood sampling was recommended if the thyroid-stimulating antibody level was abnormally high or if fetal tachycardia, goiter, intrauterine growth retardation, or hydrops were present. For fetal hyperthyroidism, the mother received antithyroid drugs; for fetal hypothyroidism, maternal antithyroid treatment was reduced, and thyroxine was injected into the amniotic sac. RESULTS: Of 40,000 deliveries, 24 pregnancies (26 fetuses) occurred in 18 women with Graves' disease. Nine of 14 mothers with positive findings elected umbilical blood sampling. In 4 of the mothers, the results were normal. Hyperthyroidism and hypothyroidism were diagnosed in 2 and 3 fetuses, respectively. All the fetuses were treated successfully by the protocol with up to four repeated umbilical blood samplings. No complications were recorded in any of the 20 umbilical blood sampling. In the 5 patients who had only elevated thyroid-stimulating antibody levels and who did not elect umbilical blood sampling, sonographic findings remained normal up to term, and the newborn infants were normal. One of 12 children (in whose case we did not recommend umbilical blood sampling) was born with transient hypothyroidism caused by maternal propylthiouracil treatment. All children, whose cases were followed for up to 9 years, are normal. CONCLUSION: In women with Graves' disease, umbilical blood sampling in selected cases may improve the control of fetal thyroid function. (Am J Obstet Gynecol 2003;189:159-65.)
A rare case of thyroid storm following caesarean section
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Thyroid storm in pregnancy is a rare life threatening emergency, with very high maternal and perinatal mortality and morbidity. Here we present an unusual case of a 30 year-old G2P1L1 woman, a known case of post caesarean pregnancy with hyperthyroidism who presented with severe preeclampsia and on second post op day developed thyroid storm. Early recognition and timely institution of appropriate management resulted in good outcome in this case.
SN Comprehensive Clinical Medicine, 2020
Graves' disease (GD) is an autoimmune thyroid disease in which stimulation by thyrotropin-receptor antibodies (TRAb) causes thyroid enlargement and hyperfunction. GD is an uncommon condition during gestation, as it occurs in about 0.2% of pregnant women. The typical GD course during gestation is characterized by a progressive reduction of TRAb levels, with associated clinical improvement, but subsequent recurrence after delivery. Instead, gestational GD requires close monitoring, because if inadequately controlled with maternal TRAb levels remaining elevated, it is associated with adverse maternal, fetal, and neonatal outcomes. We describe the case of a 39-year-old woman, who was diagnosed with stress-triggered GD at 1st trimester of her pregnancy. At diagnosis, TRAb levels were very high (30.4 U/L, normal values < 1.5). Five weeks after antithyroid drug (ATD) was started, hyperthyroidism returned, coinciding with an increase of TRAb levels (> 40 U/L). Three additional exacerbations of hyperthyroidism occurred at weeks 28 (TRAb > 40 U/L), 32 (TRAb 36.4 U/L), and 36 (TRAb 26.2 U/L), despite close biochemical monitoring and adjustments of ATD. An uncomplicated spontaneous delivery of a healthy boy occurred at week 37. The neonate had normal weight, length, Apgar score, and was euthyroid (TSH 1.9 mIU/mL). He remained healthy and euthyroid at the last evaluation (9 months of age). This case is unusual because of several exacerbations of GD hyperthyroidism while on ATD during gestation, due to persistently high TRAb levels. Nevertheless, thanks to close maternal and fetal monitoring, neither maternal nor fetal complication occurred.
Introduction: Thyroid disorder is most common in women's as compare to male population. In females, this is the most common endocrine disorder during pregnancy resulting into abnormal maternal and fetal outcomes. Pregnancy is associated with profound changes in thyroid function. Many studies have reported that thyroid prevalence shows variation with age, sex, dietary habits, stress and geographical location. Materials and methods: This study is an observational study carried on 600 women coming for antenatal checkup in Tertiary Care Hospital in Jamshedpur from January 2017-December 2017. All women who were included in this study were followed from 20-24 weeks of pregnancy up to delivery. Results: It was observed that the maximum numbers of patients were in 20-25 years (51%) age group. Euthyroid (76%), hyperthyroid (02%), subclinical hyperthyroid (02%), hypothyroid (03%), and subclinical hypothyroid (08%) cases were detected. Neonatal jaundice developed in babies of all hyperthyroid patients, 50% of patients with Subclinical hyperthyroidism, 53% of patients with Hypothyroidism, 60% of patients with Subclinical Hypothyroidism and 11% of patients with Euthyroid. Conclusion: Gestational age specific reference intervals are of utmost importance by which clinicians can reliably evaluate thyroid function and monitor thyroxine replacement therapy in pregnant women. TPOAb (Thyroid peroxidase Antibody) positive patients are associated with an increased risk of abortion and these infants are more often born preterm. TSH is the hallmark in detection of hypothyroid as well hyperthyroid so TSH should be included in the list of routine investigations done in all antenatal women in first trimester. If TSH values are abnormal then FT3, FT4 and TPOAb need to be checked.