Abstract
Thyroid crisis is an emergency in Endocrinology which is characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause. This condition is rare serious complication, affect about 1-2% of patients with hyperthyroidism. Unrecognized and untreated thyroid storm causing life threatening condition. Management of thyroid storm in pregnancy is aimed to reduce the synthesis and secretion of thyroid hormone and pregnancy management. Explain about optimal diagnostic and treatment strategies of pregnancy with thyroid storm. A 28 years woman admitted to Obstetrics Emergency Room, third pregnancy with 36 weeks 2 weeks gestation was complained of shortness of breath since 3 days ago. History of hyperthyroid since 1 year ago, often palpitate, sweating and tremor. History of consumption PTU 3x100 mg oral but lack of obey. History of hypertension since 27 weeks gestation. Physical examination found that blood pressure was 170/110 mmHg, pulse rate 130 bpm, respiratory rate bpm, 84% oxygen saturation, 38.5°C temperature. Diffuse tiroid gland was palpable with size 1 x 2 cm, ronkhi in whole lung field. Obstetric examination was found breech presentation with FHB: 131 bpm. Laboratory result were TSHs / FT4: 0.24 / 1.72, T4 Total: 104. Thyroid storm diagnostic based on Burch Wartofsky score: 55. Initial treatment performed with oxygen administration, loop diuretics, chest X-ray examination and echocardiography. Followed by PTU therapy, lugolization and corticosteroids. After 48 hours of stabilization, we performed cesarean section and postoperative care at Intensive Care Unit. Thyroid storm is rare pregnancy complication. Diagnostic criteria using Burch and Wartofsky score. Management of thyroid storm in pregnancy includes anti thyroid drugs, lugol solution, corticosteroids and pregnancy management. Diuretic therapy is given due to fluid overload, besides that screening of thyroid hormone profile is important during antenatal care.
Highlights
Thyroid crisis is an emergency in Endocrinology which is characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause
The problem of diagnosis in these patients is diagnosis of thyroid storm not immediately enforced at secondary hospitals due to the disguised of thyroid crisis diagnostic by Acute Decompensated Heart Failure (ADHF) symptoms, acute pulmonary edema and severe preeclampsia
Theoretical pregnancy will lead to increased concentration of Thyroid binding globulin (TBG) resulting in the production of thyroid hormone outside the thyroid gland increases resulting in total increase of T4 and T3.4,5 T4 metabolism increases in the second and third trimesters, due to increased deiodination of placenta type II and type III, which increases the conversion of T4 metabolism
Summary
Thyroid crisis is an emergency in Endocrinology which is characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause This condition is rare serious complication, affect about 1-2% of patients with hyperthyroidism. Thyroid storm is an Endocrinology emergency which characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause. Temporary diagnosis at Sanglah Hospital Obstetrics Emergency Room were G3P2002 36 weeks 2 days Single / Life, Breech Presentation, Severe Preeclampsia (Partial HELLP Syndrome), Impending Respiratory failure Lung Edema, Bilateral pleural effusion, hyperthyroidism, suspected cardiac abnormalities. Team meeting performed and the result were termination of pregnancy with cesarean section and tubectomy after optimizing the general condition for 48 hours with back up from Anesthesia, Pediatrics, Cardiology, Pulmonology and Internal Medicine Endocrinology Division.
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