Endocrine Abstracts

Hyperthyroidism during pregnancy is determined by decreased thyroid stimulating hormone (TSH), and high levels of thyroid hormones: thyroxine (T₄), triiodothyronine (T₃), being a complication in 1–2 women per 1,000 pregnancies, and occurs first as Graves’ disease in 0.1–1% of pregnancies. There are specific reference ranges of THS and free T₄ for each population and each trimester. For the medical management in the first trimester it is recommended propylthiouracil, and for second and third trimester is methimazole. The surgical management is recommended in the second trimester in cases of intolerance to the medication, such as allergies or agranulocytosis. Next, we describe three cases of pregnant patients who undergo surgical management with total thyroidectomy, because of intolerance to medication during second trimester, previous management with lugol. The three patients received levothyroxine post-surgical. Literature review is made.

Case 1: Age 28, gestational age=16.2 weeks. Diagnosis before pregnancy. TSH=0.00 uiu/ml, free T₄=7.77 ng/dl. At physical examination with tachycardia, hypertension, trembling limbs and aortic heart murmur. Thyroid US with heterogeneous echogenicity, echocardiogram with mild pulmonary hypertension. Initial medical treatment with methimazole 30 mg/day, lugol 6 drops every 8 hours for 10 days. Total thyroidectomy carried out without any complications. TSH=0.007, free T₄=2.95 ng/dl (post-surgical). Pregnancy termination; weight 3.100 grams and size 48 cm.

Case 2: Age 26 years, gestational age=16.3 weeks. Diagnosis before pregnancy. TSH=0.005 uiu/ml, free T₄=5,7 ng/dl. At physical examination with tachycardia, hypertension, trembling limbs. Thyroid US with diffuse goiter. Initial medical treatment with Methimazole 40 mg/day, lugol 6 drops every 8 hours for 10 days and corticosteroids. Total thyroidectomy carried out without any complications. TSH=2,4 uiu/ml, free T₄=1.23 ng/dl (post-surgical). Pregnancy termination at 38.5 gestational weeks; weight 2.946 grams and size 48 cm. TSH=3.1 uiu/ml and free T₄=1.09 after pregnancy.

Case 3: Age 21 years, gestational age=17 weeks. Diagnosis before pregnancy. TSH=0.003 uiu/ml, free T₄=6.5 ng/dl. At physical examination with tachycardia, hypertension, trembling limbs and auricular fibrillation. Thyroid ultrasonography with multinodular goiter Trads 3. Medical treatment before surgery with Methimazole 50 mg/day with intolerance, lugol 6 drops every 8 hours for 10 days and corticosteroids. Total thyroidectomy carried out without any complications. TSH=2.7 uiu/ml, free T₄=0.98 ng/dl (post-surgical). Pregnancy termination at 39.1 gestational weeks; weight 3.129 grams and size 49 cm. TSH=1.76 uiu/ml and free T₄=1.2 after pregnancy.