Successful outcome of pregnancy with severe hypothyroidism: case report and literature review

Article Abstract:

Hypothyroidism, characterized by lethargy, tiredness and disturbances in menstruation, is caused by decreased activity in the thyroid gland. A 33-year-old woman complained of lethargy and depression. Although there was a family history of hypothyroidism, this patient had normal menstrual periods, normal sized thyroid gland and normal thyroid function tests. Thyroid antibodies produced against the thyroid gland were increased slightly. In the absence of any other abnormality, the patient was referred to a psychiatrist to treat her depression. Although the patient was asked to return for periodic follow-up, she was not re-examined until three years later, when thyroid function tests measured by her general practitioner turned out abnormal. In that period she experienced three miscarriages, which were followed by a successful pregnancy and delivery. A subsequent pregnancy was electively terminated. By this time the patient was grossly hypothyroid and was started on thyroid hormone replacement therapy, thyroxine 0.05 milligrams daily to be increased to 0.1 milligrams after one month. Antibodies produced against the thyroid gland over a period of three years had caused her thyroid gland to shrink, resulting in hypothyroidism. Patients with autoimmune thyroid disease are not generally able to conceive, and if they do, the pregnancies are difficult to maintain, resulting in fetal loss. This case merits reporting since this patient conceived and delivered even though severely hypothyroid. Although the fetus' thyroid production is independent of the mother's, iodine deficiency can result if the mother's levels are too low. Furthermore, children born to mothers who are hypothyroid during pregnancy tend to score lower on intelligence tests than hypothyroid-treated mothers. Currently, there are no obvious problems in the child. It is assumed that a transient state of normal thyroid function and hormonal changes produced during pregnancy allowed this patient to conceive and deliver a normal infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Increased platelet turnover in a patient with previous recurrent pre-eclampsia and failure of aspirin therapy. Case report

Article Abstract:

Pre-eclampsia is characterized by an increase in blood pressure and edema (accumulation of fluid) during the second and third trimesters of pregnancy. It usually occurs only during the first pregnancy, but in some cases it can recur in subsequent pregnancies. It has been suggested that the increase in blood pressure may be caused by thromboxane (TBX). TBX is made by blood cells called platelets (cells that are important for blood clot formation). TBX causes blood vessels to constrict and blood pressure to increase. Some cases of pre-eclampsia can be treated with aspirin because aspirin prevents platelets from making TBX, thereby preventing blood pressure from increasing. However, not all cases of pre-eclampsia respond to treatment with aspirin. This article describes the case report of a 36-year-old woman who had four unsuccessful pregnancies that were complicated by high blood pressure and pre-eclampsia. During the woman's fifth pregnancy she was treated with aspirin in an attempt to prevent pre-eclampsia. However, aspirin treatment was not effective, pre-eclampsia occurred, and the fetus died at week 24 of gestation. Tests were performed to determine the underlying causes of the high blood pressure and the five unsuccessful pregnancies. Conditions that were ruled out included pheochromocytoma (an adrenal gland tumor that causes blood pressure to increase), systemic lupus erythematosus (a connective tissue disease that has been associated with unsuccessful pregnancies), and kidney disease. Further studies revealed that the woman had platelets with an abnormally short life span. The net result was that more TBX was made; aspirin is not as effective in preventing platelets from producing TBX. This may account for the lack of effect of aspirin in this patient. The cause of the short life span of the platelets is unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, Drug therapy, Blood platelets, Aspirin

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Hypothyroidism presenting as hypothermia following preeclampsia at 23 weeks gestation. Case report and review of the literature

Article Abstract:

Hypothyroidism is characterized by a deficiency of thyroid hormone. It causes a reduction in the rate of metabolism and reduces growth rate, heart rate, mental ability, muscle strength, and increases sensitivity to cold temperatures. Women who have hypothyroidism are unlikely to become pregnant because of abnormal ovulation. When pregnancy occurs in a woman with hypothyroidism, there is an increased risk of miscarriage, preterm birth, stillbirth, and birth defects. Also, a recent study reported a high incidence of pre-eclampsia, high blood pressure and fluid retention (edema) during pregnancy, in women with hypothyroidism. This article describes the case report of a 21-year-old pregnant woman with hypothyroidism who developed pre-eclampsia at week 23 of gestation. She had difficulty swallowing, a hoarse voice, and edema in the face and legs. She was diagnosed with pre-eclampsia, and as her condition became worse it was recommended that the pregnancy be terminated. Twenty-four hours after the pregnancy was terminated her body temperature was abnormally low, and the edema in the face was still present. At this stage the patient was diagnosed with severe hypothyroidism, which was confirmed by thyroid function tests. She was treated with steroids and her body temperature returned to normal. Thyroxine replacement therapy for hypothyroidism was started and the patient had a successful recovery. In this patient, it appears that the effects of the pre-eclampsia masked the effects of hypothyroidism, making it difficult to diagnose. It is concluded that thyroid function tests should be performed in pregnant women who develop pre-eclampsia to allow the early detection and treatment of thyroid disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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