A unique presentation of Graves’ disease in a pregnant woman with severe hypothyroidism

Abstract

Background

Graves’ disease occurrence during pregnancy is not a frequent event, showing an incidence of 0.2-0.4% in unselected pregnant women. Depending on their functional properties, TSH-receptor antibodies can induce hypothyroidism or hyperthyroidism. Recognizing the signs of altered thyroid function is essential to prevent possible complications on the fetus.

Materials and methods

The case of a pregnant woman without previous history of thyroid disease presenting with severe overt hypothyroidism during the first trimester is reported. Levothyroxine therapy was started and 6 weeks later overt hyperthyroidism was observed. TRAb were detected at high titers. Levothyroxine was withdrawn and low dose methimazole was started. Serial obstetric ultrasound scans were negative for indirect signs of fetal thyroid dysfunctions and no fetal goiter was visualized throughout pregnancy. Spontaneous delivery occurred without complications at 39 weeks of gestation. In the post-partum, severe overt hypothyroidism recurred, thus methimazole was discontinued and levothyroxine was restarted. TRAb persisted at high levels. The infant experienced a transient thyrotoxicosis, which fully resolved in three months with normalization of thyroid function and negativization of TRAb levels.

Results

The present case report allows us to overview the challenges related to the management of hypo and hyperthyroidism in patients with high TRAb levels, requiring strict monitoring aimed at early detection of both maternal and fetal consequences.

Conclusions

This case underlines the importance of close follow-up and the need of collaboration in a multidisciplinary team when Graves’s disease is diagnosed in a pregnant woman to prevent adverse neonatal outcomes.

摘要

背景

妊娠期Graves病发生并不常见，在未经选择的孕妇中的发病率为0.2-0.4%。根据其功能特性，TSH受体抗体可导致甲状腺功能减退或甲状腺机能亢进。识别甲状腺功能改变的迹象对于预防胎儿可能出现的并发症至关重要。

材料与方法

本文报告一例无甲状腺病史的孕妇，在妊娠早期出现严重的显性甲状腺功能减退。开始左旋甲状腺素治疗，6周后出现明显的甲状腺机能亢进。TRAb效价高。停用左旋甲状腺素，开始小剂量甲硫咪唑治疗。连续的产科超声检查对胎儿甲状腺功能障碍的间接迹象是阴性的，在整个怀孕期间没有看到胎儿甲状腺肿。妊娠39周自然分娩，没有并发症。在产后，严重的显性甲状腺功能减退复发，因此停用甲硫咪唑，并重新开始应用左旋甲状腺素。TRAb一直维持在较高水平。婴儿经历了一过性甲状腺毒症，在3个月内完全消失，甲状腺功能正常，TRAb水平阴性。

结果

本病例报告使我们能够概述与治疗TRAb水平高的患者甲状腺功能减退和甲状腺功能亢进相关的挑战，需要进行严格的监测，旨在及早发现母婴结局。

结论

这一病例强调了当孕妇被诊断为Graves病时，密切随访的重要性和多学科团队合作的必要性，以预防不良的新生儿结局。

Keywords:

• Thyroid
• Graves’disease
• hypothyroidism
• pregnancy
• TRAb

关键词:

• 甲状腺
• Graves病
• 甲状腺功能减退
• 妊娠
• TRAb

Data availability statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Disclosure statement

The authors have no conflicts of interest to declare.

Funding

The author(s) reported there is no funding associated with the work featured in this article.