Abstract
BackgroundSubacute thyroiditis (SAT) is rarely diagnosed in pregnant women, and only 7 cases have been reported to date. Thyroid dysfunction, especially hyperthyroidism, during pregnancy has been associated with both maternal and neonatal complications. Thus, the early diagnosis and treatment of SAT during pregnancy may be beneficial. We present a case report and literature review to complement the diagnostic evaluation and management of SAT during pregnancy.Case presentationA 27-year-old woman presented in gestational week 17 of her first pregnancy and had a negative prior medical history. She presented to the Endocrinology Department complaining of neck pain for one month that had intensified in the last five days. Physical examination revealed a diffusely enlarged thyroid gland that was firm and tender on palpation. The patient also had an elevated temperature and heart rate. The increasing and long-lasting pain coupled with a decreased level of thyroid-stimulating hormone indicated hyperthyroidism. Ultrasound findings were indicative of SAT. Importantly, the pain was so severe that 10 mg of oral prednisone per day was administered in gestational week 18, which was increased to 15 mg/d after 10 days that was discontinued in week 28. Levothyroxine was started in gestational week 24 and administered throughout the pregnancy. The patient responded well to the treatments, and her neck pain disappeared in gestational week 21. She gave birth to a healthy male in gestational week 41.ConclusionSAT can be diagnosed and effectively managed during pregnancy, thus benefiting mothers and infants.
Highlights
Subacute thyroiditis (SAT) is rarely diagnosed in pregnant women, and only 7 cases have been reported to date
The incidence of maternal thyroid disorders remains high during pregnancy, with hypothyroidism affecting up to 2%—3% of all pregnancies and hyperthyroidism affecting 0.1%—0.4%
Laboratory examination tends to show an increase in the level of erythrocyte sedimentation rate (ESR), white blood cell count, C-reactive protein (CRP), and other indicators of infection, coupled with the low echogenicity of nodules
Summary
The incidence of maternal thyroid disorders remains high during pregnancy, with hypothyroidism affecting up to 2%—3% of all pregnancies and hyperthyroidism affecting 0.1%—0.4%. Case presentation A 27-year-old women in the 17th week of gestation in her first pregnancy presented to the Endocrinology Department of our hospital complaining of neck pain for one month that had intensified in the last five days. Thyroid function test results in the 14th week of gestation were as follows: T4 222.1 ng/ mL; T3 3.07 ng/mL; and, TSH 0.058 ulU/mL (Table 1, Fig. 1). The thyroid function and ESR were normal in the 2 7th week of gestation (Table 1, Fig. 1) and ,prednisone treatment was stopped in the 28th week but levothyroxine was continued. The dose of levothyroxine was increased to 50 ug per day until delivery Throughout this time the patient’s TSH level was maintained at 2.26–3.01 ulU/mL (Table 1, Fig. 1). Severe nausea and gland texture per day, pregnancy vomiting was terminated due to severe nau‐
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