Endocrine Abstracts

Introduction: Thyrotoxicosis syndrome is a clinical syndrome, associated with the negative effect of strong thyroid hormone excess on the organism. In most cases women with thyrotoxicosis syndrome in postpartum period have postpartum thyroiditis, caused by reactivation of the immune system after gestational suppression. However sometimes Graves disease can manifest during the postpartum period, this condition also results in thyrotoxicosis syndrome and requires radical thyroidectomy. Thus determining the cause of the thyrotoxicosis syndrome is an important part of the diagnostic process and, consequently, choosing of treatment tactic in patients with thyroid pathology in postpartum period.

Clinical case: A 23-year-old woman presented with discomfort and dryness of eyes, tremor, constant feeling of heat and stuffiness, excessive sweating, rapid heart rate, weight loss, irritability and nervousness, headache, increased frequency of stools. In October 2016 she had a baby and complains has developed since March 2017, a thyroid ultrasound revealed increased thyroid volume (26.3 cm³) and diffuse changes similar to autoimmune thyroiditis. The symptoms have become worse since September 2017: heart rate increased, there were significant changes in periorbital region and the patient consulted an endocrinologist. It’s known from social history that the patient smokes. Physical examination: thyroid gland was visually enlarged, firm, homogeneous. The patient was presumed to have the thyrotoxicosis syndrome, and the laboratory examination showed decreased level of TSH (0.005 mIU/l) and increased levels of: fT3 (>41.0 pmol/l), fT4 (>76.0 pmol/l) and TSH-receptor antibodies (TRAb) (>40 IU/l). Thyroid ultrasound revealed enlarged thyroid gland (66.6 cm³). The thyroid radioactive iodine uptake test also showed significantly enlarged thyroid gland and diffusely increased iodine uptake, especially in the right lobe. Taking into consideration low TSH level, high levels of fT3 and fT4 and TRAb, ultrasound and thyroid radioactive iodine uptake test findings, Graves disease was diagnosed and thyroidectomy was performed in September 2017. Pathological analysis of the patient’s lesion confirmed the diagnosis of Graves disease. L-thyroxin 75 μg was administered 1 time a day 30 minutes before breakfast and taking other medications. TSH and free T4 monitoring was planned 3 months later after administration.

Conclusion: This case shows how important is proper and early diagnosis of causes of the thyrotoxicosis syndrome in postpartum period, such as diffuse toxic goiter and postpartum thyroiditis. These actions have allowed to choose the right treatment tactic and to perform surgical resection of the thyroid gland, and as a result, to achieve a positive prognosis.