Thyroidectomy in Pregnant Patient with Grave’s Disease Without Response to Medical Treatment: Case Report
Published
May 7, 2020
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Elly Morros González
https://orcid.org/0000-0002-7946-3379
Leonardo Javier Rojas Melo
https://orcid.org/0000-0002-8876-937X
Viviana Cruz Ramírez
https://orcid.org/0000-0002-8360-6192
Angélica Imitola
https://orcid.org/0000-0002-1896-8410
https://orcid.org/0000-0002-7946-3379
Leonardo Javier Rojas Melo
https://orcid.org/0000-0002-8876-937X
Viviana Cruz Ramírez
https://orcid.org/0000-0002-8360-6192
Angélica Imitola
https://orcid.org/0000-0002-1896-8410
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Abstract
Objective: To describe the case of a pregnant patient with Graves’ disease who presented inadequate response to antithyroid medications with the aim to present the alternative therapeutics options such as cholestyramine, steroids, potassium iodide, plasmapheresis and thyroidectomy. Material and methods: 18 years-old-female patient, with 25-week pregnancy and history of Graves’ disease for 2 years, treated with high doses of methimazole and propranolol. Results: Post-surgical evolution was satisfactory; patient was discharged with levothyroxine 100 mg/day treatment. At the 39th week of gestation, a healthy female baby was born, weighting 3200 grams with a normal neonatal TSH 6.21 mU/ml (0-15). Conclusions: Thyroidectomy at the end of the second trimester in pregnant women with Graves’ disease may be a favorable therapeutic alternative in case of inadequate response to medical treatment.
Keywords
thyroidectomy, Graves' disease, hyperthyroidism, pregnancy, thyroid crisistiroidectomía, enfermedad de Graves, hipertiroidismo, embarazo, crisis tiroidea
References
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14. Glinoer D. The Systematic Screening and Management of Hypothyroidism and Hyperthyroidism During Pregnancy. Trends Endocrinolo Metabl.1998;9(10): 403-11.
15. Lazarus JH. Management of hyperthyroidism in pregnancy. Endocrine. 2014; Vol. 45; p. 190–4.
16. Laurberg P, Andersen SL. Antithyroid drug use in early pregnancy and birth defects: Time windows of relative safety and high risk?. European Journal of Endocrinology. 2014; Vol. 171.
17. Hoon Yim C. Update on the Management of Thyroid Disease during Pregnancy. org Endocrinol Metab. 2016;31:386–91.
18. Li H, Zheng J, Luo J, Zeng R, Feng N, Zhu N, et al. Congenital anomalies in children exposed to antithyroid drugs in-utero: A meta-analysis of cohort studies. PLoS One. 2015;10(5):1–11.
19. Laurberg P, Andersen SL. Pregnancy and the incidence, diagnosing and therapy of Graves’ disease. European Journal of Endocrinology. Vol. 175, 2016. p. R219–30.
20. Yoshioka W, Miyauchi A, Ito M, Kudo T, Tamai H, Nishihara E, et al. Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease. Endocr J. 2016;63(2):179.
21. Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: Focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. European Journal of Endocrinology.Vol. 160, 2009. p. 1–8.
22. Alsanea O, Clark OH. Treatment of graves ’ disease : the advantages of surgery. Endocrinol Metab Clin North Am. 2000;29(2):321–37.
23. Li X, Liu G, Ma J, Zhou L. Risk of congenital anomalies associated with antithyroid treatment during pregnancy: a meta-analysis. Clinics (Sao Paulo). 2015;70(6):453–9.
24. Li H, Zheng J, Luo J, Zeng R, Feng N, Zhu N, et al. Congenital anomalies in children exposed to antithyroid drugs in-utero: A meta-analysis of cohort studies. PLoS One. 2015;10(5).
25. Bilir BE, Atile NS, Kirkizlar O, Ko Y, Akpinar S, Sezer A, et al. Effectiveness of preoperative plasmapheresis in a pregnancy complicated by hyperthyroidism and anti-thyroid drug-associated angioedema. Gynecological Endocrinology. 2013;3590(5):508–10.
2. Nathan N, Sullivan SD. Thyroid disorders during pregnancy. Endocrinology and Metabolism Clinics of North America. 2014. Vol. 43,p. 573–97.
3. Brent GA. Graves ’ Disease. N Engl J Med. 2008; 12;358 (24) 2594–605.
4. Hainet D, Martínez V, Mercedes ID, Caridad D, Ii HH. Hipertiroidismo y embarazo Hyperthyroidism and pregnancy. Revista Cubana de Endocrinología 2012;23(3):299–305.
5. Nachum Z, Rakover Y, Weiner E, Shalev E. Graves ’ disease in pregnancy : Prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol. 2003;189 (1): 159-65.
6. Krajewski DA, Burman KD. Thyroid disorders in pregnancy. Vol. 40, Endocrinology and Metabolism Clinics of North America. 2011. p. 739–63.
7. Carlos J, Ferrater G, Corrales JJ. Artículos especiales Guía clínica para el diagnóstico y el tratamiento de la disfunción tiroidea subclínica en la gestación. 2009;56(2):85–91.
8. Graves hyperthyroidism AND pregnancy :A clinical Review. Clin Diabetes endocrinolo. 2010;16(1):90033.
9. Cooper DS, Laurberg P. Hyperthyroidism in Pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238–49.
10. Grigoriu C, Cezar C, Grigoras M, Horhoianu I, Parau C. Management of hyperthyroidism in pregnancy. J Med Life. 2008;1(4):390–6.
11. Alexander AEK, Pearce EN. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. 2017. Thyroid. 2017.
12. Stagnaro-Green A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011;54(3):478–87.
13. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis. Thyroid [Internet]. 2016;26(10):1–272.
14. Glinoer D. The Systematic Screening and Management of Hypothyroidism and Hyperthyroidism During Pregnancy. Trends Endocrinolo Metabl.1998;9(10): 403-11.
15. Lazarus JH. Management of hyperthyroidism in pregnancy. Endocrine. 2014; Vol. 45; p. 190–4.
16. Laurberg P, Andersen SL. Antithyroid drug use in early pregnancy and birth defects: Time windows of relative safety and high risk?. European Journal of Endocrinology. 2014; Vol. 171.
17. Hoon Yim C. Update on the Management of Thyroid Disease during Pregnancy. org Endocrinol Metab. 2016;31:386–91.
18. Li H, Zheng J, Luo J, Zeng R, Feng N, Zhu N, et al. Congenital anomalies in children exposed to antithyroid drugs in-utero: A meta-analysis of cohort studies. PLoS One. 2015;10(5):1–11.
19. Laurberg P, Andersen SL. Pregnancy and the incidence, diagnosing and therapy of Graves’ disease. European Journal of Endocrinology. Vol. 175, 2016. p. R219–30.
20. Yoshioka W, Miyauchi A, Ito M, Kudo T, Tamai H, Nishihara E, et al. Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease. Endocr J. 2016;63(2):179.
21. Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: Focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. European Journal of Endocrinology.Vol. 160, 2009. p. 1–8.
22. Alsanea O, Clark OH. Treatment of graves ’ disease : the advantages of surgery. Endocrinol Metab Clin North Am. 2000;29(2):321–37.
23. Li X, Liu G, Ma J, Zhou L. Risk of congenital anomalies associated with antithyroid treatment during pregnancy: a meta-analysis. Clinics (Sao Paulo). 2015;70(6):453–9.
24. Li H, Zheng J, Luo J, Zeng R, Feng N, Zhu N, et al. Congenital anomalies in children exposed to antithyroid drugs in-utero: A meta-analysis of cohort studies. PLoS One. 2015;10(5).
25. Bilir BE, Atile NS, Kirkizlar O, Ko Y, Akpinar S, Sezer A, et al. Effectiveness of preoperative plasmapheresis in a pregnancy complicated by hyperthyroidism and anti-thyroid drug-associated angioedema. Gynecological Endocrinology. 2013;3590(5):508–10.
How to Cite
Morros González, E., Rojas Melo, L. J., Cruz Ramírez, V., & Imitola, A. (2020). Thyroidectomy in Pregnant Patient with Grave’s Disease Without Response to Medical Treatment: Case Report. Universitas Medica, 61(3). https://doi.org/10.11144/Javeriana.umed61-3.grav
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Case Reports