Tiroidectomía en paciente embarazada con enfermedad de Graves sin respuesta a tratamiento médico: reporte de caso
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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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Resumen
Objetivo: Describir el caso de una paciente embarazada con enfermedad de Graves sin respuesta a antitiroideos, a fin de exponer las opciones terapéuticas adicionales disponibles como colestiramina, corticoesteroides, yoduro de potasio, plasmaféresis y tiroidectomía. Materiales y métodos: Se presenta el caso de una mujer de 18 años de edad con embarazo de 25 semanas y enfermedad de Graves desde hace 2 años, tratada con altas dosis de metimazol y propranolol. Se consideró diagnóstico de preeclampsia y tormenta tiroidea probable (Burch Wartofsky 25). Resultados: La evolución clínica posoperatoria fue satisfactoria; la paciente fue dada de alta con tratamiento sustitutivo con levotiroxina de 100 µg/día. A las 39 semanas de gestación, nació por cesárea una niña sana con peso 3200 g con medición de TSH neonatal en 6,21 mU/ml (0-15). Conclusiones: La tiroidectomía al final del segundo trimestre es una alternativa terapéutica favorable en pacientes embarazadas con enfermedad de Graves sin respuesta al tratamiento médico
Keywords
thyroidectomy, Graves' disease, hyperthyroidism, pregnancy, thyroid crisistiroidectomía, enfermedad de Graves, hipertiroidismo, embarazo, crisis tiroidea
References
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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.
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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.
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.
Cómo citar
Morros González, E., Rojas Melo, L. J., Cruz Ramírez, V., & Imitola, A. (2020). Tiroidectomía en paciente embarazada con enfermedad de Graves sin respuesta a tratamiento médico: reporte de caso. Universitas Medica, 61(3). https://doi.org/10.11144/Javeriana.umed61-3.grav
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Reportes de caso