Postpartum thyrotoxic crisis diagnosed as Graves’ disease : a case report

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  • NAGATA Natsuko
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • FUKUDA Aya
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • MARUMOTO Eriko
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • KANAO Serika
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • NISHIYAMA Rie
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • KISHIMOTO Toshiko
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital
  • OGAWA Haruki
    Department of Obstetrics and Gynecology, Osaka Kouseinenkin Hospital

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Other Title
  • 分娩後に甲状腺クリーゼを発症し，バセドウ病と診断された1例
  • 症例報告 分娩後に甲状腺クリーゼを発症し,バセドウ病と診断された1例
  • ショウレイ ホウコク ブンベン ゴ ニ コウジョウセン クリーゼ オ ハッショウ シ,バセドウビョウ ト シンダン サレタ 1レイ

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Abstract

Thyrotoxic crisis typically occurs in patients in whom preexisting hyperthyroidism has not been diagnosed or has been treated insufficiently. The crisis has an abrupt onset, and is sometimes evoked by delivery. We herein report the case of a patient who developed thyroid crisis after delivery. A 28-year-old female who had fatigability and tachycardia but was followed as a normal pregnancy delivered a 2.06 kg baby at 35 weeks of gestation. The baby’s Apgar score was 2 at 1 minute and 3 at 5 minutes. He was transferred to a hospital equipped with a NICU. One hour later, the patient developed dyspnea, tachycardia, and hypertension. She was suspected to have a pulmonary thromboembolism or preeclampsia by an obstetrician at that clinic, and was transferred to the emergency department of our hospital. On arrival she had a disturbance of consciousness, and she showed tachycardia, hypertension, dyspnea, and a swollen neck. Ultrasonography revealed a swollen thyroid with elevated blood flow and severe heart insufficiency. She was diagnosed with heart failure caused by thyroid storm, and immediate treatment was started with a thyroid antagonist, potassium iodide and methylprednisolone in the intensive care unit. The tachycardia and thyrotoxicosis were improved within 24 hours, and she was discharged on postpartum day 14. Thyrotoxic crisis is a rare but often fatal condition. Therefore, it should be kept in mind that postpartum shock can lead to such disorders. This case may suggest that screening for thyroid function during pregnancy can prevent severe complications, such as cardiac failure. [Adv Obstet Gynecol, 65(2) : 146 - 152 , 2013 (H25. 5)]

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