Endocrine Abstracts

30 yr/F, presented with C/O of palpitations, heat intolerance, significant unintentional weight loss with bulging of eyes and diplopia on extremes of vision. She had a background history of asthma, PCOS, obesity and difficulty in conceiving. OE, there was a smooth painless goiter. TFTs at diagnosis: TSH <0.05, T4=83, T3 >30.8 and TSH receptor antibody level (TRAB) of 9.0. She developed skin reaction to both Carbimazole and PTU, hence treated with total thyroidectomy with lifelong thyroxine replacement. Subsequently she was reviewed 3 months after surgery, at that time she was 7 weeks pregnant and was started on levothyroxine 125mg od. She remained biochemically euthyroid throughout pregnancy but TRAb remained positive at 8.9, 4.8 and 4.4 at 13, 24 weeks and 28 weeks gestation respectively. She had an emergency C- section at 38 weeks due to fetal macrosomia. Baby had resuscitation for 6 mins and was taken to neonatal ITU, as he developed meconium aspiration syndrome and PPHN (persistent pulmonary hypertension of newborn) and neonatal thyrotoxicosis TFTs on day 1 showed low TSH level of <0.02, T3 5.8, T4 29.8 and TRAb was positive and he was started on carbimazole at 0.4mg/kg/day on day 8. He remained in hospital for 25 days when repeat bloods showed evidence of remission, hence Carbimazole was stopped. Repeat bloods after 1 week of discontinuing carbimazole showed biochemical evidence of hyperthyroidism and thus he was restarted on carbimazole 0.5 mg/kg/day (2.5 mg od) alongwith propranolol 250 mcg/kg every 8 h. 2 weeks later his TFTs still showed raised T4, hence carbimazole increased to 4 mg. Apart from on and off diarrhea, baby was thriving and gaining weight with no clinical evidence of hyperthroidism.1 months later his TFTs were normalized and hence Carbimazole was stopped and repeat TFTs arranged in 2/7.