Endocrine Abstracts

Introduction

The global pandemic caused by the SarsCov2 virus has brought great challenges to the medical system, the management of some cases, especially for those belonging to risk categories, such as pregnant women, being often difficult in this context. Telemedicine has been used frequently during this period, facilitating reducing patient’s risk for exposure to COVID-19, providing continuous support, and coordinating the necessary services to prevent acute care necessity, or in our case mother/child short-term/long-term complications.

Objective

Presenting the management during the pandemic, of a case with Graves’ disease in pregnancy, using telemedicine.

Case-presentation

A 27-year-old female patient, known with Graves’ disease, previously treated with Methimazole (MMI), discontinued on her own decision, addresses to our clinic on 31.03.2020, following an obstetrical consultation (on 26.03.2020) which confirmed that she was 7 weeks pregnant. The hospital to which our clinic belongs, treats patients with Covid19, so we preferred to avoid the patient’s exposure, thus management was assessed through telemedicine. We recommended her to perform thyroid functional and immunological tests (FT4, FT3, TRAb) complete blood count and liver function tests, the results confirming Graves’ hyperthyroidism. Antithyroid drugs (ATD) therapy was restarted (Propylthiouracil 50 mg, 3 × 1/day), subsequently periodically monitoring the biological parameters, as well as clinical parameters, weight as well as blood pressure and heart rate. She did not require ß-blockers therapy. Entering the second trimester, PTU was replaced with MMI, starting with a dose of 7.5 mg/day, followed by dose adjustment as the pregnancy progressed.

Results:

It was possible to obtain a favorable evolution of the thyroid functional parameters and the decrease of the necessary ATD dose to a minimum required level. Pregnancy ended successfully. At 39 weeks of gestation, she gave birth, by caesarean section, to a healthy female newborn, weighing 3290 grams, Apgar score 9; with favourable postpartum evolution for both mother and newborn. The newborn was screened for thyroid dysfunction after birth and both, functional and immunological thyroid tests, were normal. The patient continued postpartum, after breastfeeding, with MMI therapy 2.5 mg daily, thyroid functional parameters being within normal range.

Conclusions

The SarsCov2 pandemic imposed the consultation and management of several patients by using telemedicine, to avoid the risk of viral exposure. Once established the diagnosis, the adjustment of ATD for Graves’ disease during pregnancy was possible using telemedicine. In this case we succeed to manage it even during these difficult conditions, with favorable results so far, both for mother and child.