Endocrine Abstracts

Background: Graves’ disease exacerbations during pregnancy usually occur in the first trimester with very rare cases of disease manifestation or relapse in second/third trimester. Up to five percent of neonates that are born to women with diffuse toxic goiter develop symptoms of hyperthyroidism because of transplacental transfer of TSH-receptor autoantibodies.

Case presentation: Female, born in year 1990, with a history of symptomatic autoimmune hyperthyroidism first diagnosed in 2017. At the time she received thyrostatic therapy with Carbimazole with good results and stable remission during first pregnancy and delivery in February 2021. Relapse of autoimmune hyperthyroidism occured in January 2022, when the patient developed active severe Graves’ orbitopathy in the 26th week of her second pregnancy. Outpatient therapy with Thiamazole 10 mg twice daily, and Anaprilin 20 mg twice daily was initiated. Due to active severe Graves’ orbitopathy, the patient received a course of intravenous Methylprednisolone 500 mg once weekly for 5 weeks, but the treatment was discontinued due to arterial hypertension and malaise. The pregnancy ended in spontaneous vaginal delivery in week 35⁺⁶ with the newborn exhibiting symptoms of increased appetite, restlessness, and tachypnoea. The newborn was hospitalized at Children’s Clinical University Hospital where neonatal thyrotoxicosis was diagnosed. At the time the patient discontinued breast-feeding after two weeks, and the dose of intravenous Methylprednisolone was increased to 500 mg 1x/week, and the dose of Thiamazole was increased to 30 mg daily. In control blood tests free thyroid hormones are normalizing, orbitopathy symptoms are decreasing over time.

Conclusions: Early diagnosis of autoimmune hyperthyroidism and achieving optimal disease compensation for the mother, is important for reducing complications in pregnancy outcomes, and maintaining the health of the mother and newborn.