Abstract #1413864: Perioperative Management of Hyperthyroidism in Molar Pregnancy: A Case Report

Abstract

Hyperthyroidism is a rare complication of molar pregnancy. Perioperative management in hyperthyroidism treatment needs a comprehensive approach. A 23-year-old woman with molar pregnancy at 11 weeks of gestation was consulted for perioperative consultation for an emergency dilatation and curettage by the obstetrics and gynecology department. She had a chief complaint of intermittent light bleeding from the vagina two weeks ago. Due to the bleeding, she changed her pads twice a day. She also complained of a decreased body weight for one month, with a loss of about 4 kg, tremors, and irregular menstruation. She has had general weakness since last month. On physical examination, she was tachycardic (119 bpm). She showed a resting tremor on both hands. Significant laboratory findings included a hemoglobin concentration was 6.7 g/dL, increased transaminase (AST 109 unit/L and ALT 81 unit/L), increased fT4 (7.77 ng/dL), and decreased TSH (0.01 micro IU/mL). Propylthiouracil (PTU) 200 mg every 4 hours and dexamethasone 5 mg every 12 hours were administered before the surgery as a treatment for hyperthyroidism while receiving a transfusion to correct her hemoglobin concentration. She was curetted without any complications. She has a molar pregnancy which causes increased human chorionic gonadotropin. Its alpha subunit has a similar structure to TSH that can bond to TSH receptors on thyroid cells, leading to increased circulation of fT4. Pregnancy termination is indicated if patients present with significant thyrotoxicosis and bleeding. However, hyperthyroidism carries an increased risk for thyroid storm in surgery. PTU administration aims to inhibit the thyroid peroxidase enzyme that converts iodide to an iodine molecule and incorporates the iodine molecule into the amino acid tyrosine, decreasing T4 production. She was given a steroid (dexamethasone) to inhibit peripheral conversion from T4 to T3.