Endocrine Abstracts

Introduction: Thyroid health in pregnancy is highly important. Best way to evaluate thyroid in pregnancy, is thyroid function assessment via blood tests. But we always have to focus also on clinical manifestations, thyroid ultrasound and other factors, that may influence test results. As we know high HCG can suppress TSH and twin pregnancy may induce subclinical hyperthyroidism. There are many reports of twin pregnancies, but very few about triplet pregnancy. Therefore we decided to report this rare case.

Case report: 34 y/o women presented with triplet pregnancy on 12 weeks of gestation. Routine thyroid tests showed laboratory picture of overt hyperthyroidism: TSH- <0.005 (0.3-2.5); FT3-3.98 (2-4.4); FT4- 1.89 (0.93-1.7). On clinical evaluation she had no signs of GO. HR-98, BP-120/80, BMI-18.6. Patient had hyperemesis gravidatum. She lost 6 kg during pregnancy. In previous 2 pregnancies she had normal thyroid functions. Positive family history of AIT. We ordered Anti-TSHR- N, thyroid ultrasound- N. Considering additional tests and mild clinical symptoms, we choose watchful waiting, to distinguish between overt thyrotoxicosis and transient hyperthyroidism of early pregnancy. After 3 weeks laboratory tests came already normal. TSH-0.22; FT4-0.93. We ordered TSH every month thereafter and it stayed in normal trimester-specific range on every occasion. Patient gave birth on 39 weeks of gestation with 3 healthy babies.

Conclusion: Because of potential harm and evidence of fetal risks, we have to be very careful with initiating of Anti-thyroid medications and avoid overusing them, if we don’t have clear diagnosis. As we see in 2-3 weeks thyroid functions may improve by themselves. Also many criteria can help clinicians to distinguish very carefully between real thyrotoxicosis and transient state. Multiple pregnancy is one sign, we must take into account.