Gestational Transient Thyrotoxicosis Complicated by Thyroid Storm in a Patient With Hyperemesis Gravidarum

Risk factors associated with gestational transient thyrotoxicosis and their effects on the pregnancy course

OBJECTIVE

To investigate the clinical characteristics of patients with gestational transient thyrotoxicosis and its possible impacts on pregnancy.

METHODS

This retrospective study included pregnant women with gestational transient thyrotoxicosis who were admitted to our endocrinology outpatient clinic from June 2020 to March 2023. Patients with other causes of thyrotoxicosis, such as Graves' disease, toxic nodular goiter, and subacute thyroiditis, were excluded.

RESULTS

The study included 50 pregnant women who met the inclusion criteria and whose data could be accessed. Two pregnant women were diagnosed with gestational diabetes, and two pregnancies resulted in abortion. We observed that thyroid-stimulating hormone levels normalized to euthyroid values at a mean gestational age of 18.3 ± 3.7 weeks. The mean gestational age at birth was 38 ± 1.8 weeks. The frequency of preterm labor, defined as delivery before 37 weeks, was 10% (n = 5). Sinus rhythm was observed in 87% of the electrocardiograms obtained during thyrotoxicosis, while sinus tachycardia was detected in four and sinus arrhythmia in two cases. Thyroid nodules were observed in 23 (47.9%) of 48 cases in which ultrasonography was performed during thyrotoxicosis. Discussion: This retrospective study, including 50 pregnant women with gestational transient thyrotoxicosis, found no increase in the rate of serious obstetric complications such as eclampsia/preeclampsia, gestational diabetes, preterm labor, or abortion. Notably, in a detailed examination of electrocardiograms, which has not been done in previous studies, we did not detect any serious, life-threatening arrhythmias, although tachycardia was observed.

Thyroid storm: hyperemesis and second trimester miscarriage

Thyroid storm is a rare and life-threatening endocrine emergency. This complication is typically seen in women with a history of thyroid disorders triggered by a stressor such as surgery, trauma or severe illness. In pregnancy, there is significant fetal morbidity including preterm birth or fetal death. We present a case of thyroid storm in the second trimester precipitated by hyperemesis gravidarum and gestational transient thyrotoxicosis which was complicated by maternal collapse, miscarriage and cardiomyopathy.

An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave

Graves' disease (GD) and gestational transient thyrotoxicosis (GTT) are the most common causes of thyrotoxicosis during pregnancy, with prevalence ranging from 0.1% to 1% and from 1% to 3%, respectively. Hyperthyroidism during pregnancy can have severe consequences if not promptly recognized and treated. Even more severe, if possible, is the thyroid storm, a life-threatening complication of hyperthyroidism, characterized by severe and dramatic clinical manifestations of thyrotoxicosis. No prior history of thyroid disease, absence of GD stigmata, negative thyrotropin (TSH) receptor antibody levels, serum human chorionic gonadotropin (hCG) higher on average, and symptoms of emesis may lead to the diagnosis of GTT. Few cases of thyroid storm during pregnancy are reported in literature, mainly due to gestational trophoblastic disease. We report a rare and severe case of thyroid storm in a 24-year-old woman at 15 weeks' gestation with twins, likely due to GTT, precipitated by acute myocarditis. Initially presenting with weakness, vomiting, and sinus tachycardia, the patient rapidly deteriorated into a life-threatening condition characterized by hypokalemia, myocardial injury, and severe thyrotoxicosis. Cardiac imaging later revealed acute myocarditis. Thyroid function stabilized at the end of the pregnancy, allowing discontinuation of methimazole. Both fetuses were delivered via emergency cesarean section at 36 weeks, with no significant congenital abnormalities. This case highlights the complexity of diagnosing and managing hyperthyroidism in twin pregnancies, particularly in the context of hyperemesis gravidarum (HG).

Thyroid storm in pregnancy: a review

BACKGROUND

Thyroid storm is a state of circulating thyroid hormone excess leading to multiorgan dysfunction and systemic decompensation. It typically occurs in the setting of poorly controlled hyperthyroidism and a precipitating illness or event. Management of thyroid storm in pregnancy poses unique diagnostic and therapeutic challenges.

MAIN BODY

Thyroid storm is a clinical diagnosis characterized by hyperpyrexia, tachyarrhythmias, congestive heart failure, gastrointestinal and neuropsychiatric disturbances. However, diagnostic scoring systems have not been validated in pregnancy. Treatment involves specialist consultation, supportive care, and pharmacological options such as anti-thyroid medications, beta blockers, iodine solutions, glucocorticoids, and cholestyramine. These must be adapted and modified in pregnancy to prevent fetal and maternal complications.

CONCLUSION

There is a critical need to recognize thyroid storm during pregnancy and initiate proper medical interventions promptly.