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 tre...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-01-01
|
| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/crie/6298137 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841524912125116416 |
|---|---|
| author | Virginia Maltese Elisa Gatta Irene Silvestrini Valentina Anelli Francesca Bambini Caterina Buoso Maria Cavadini Massimiliano Ugoccioni Maura Saullo Fiorella Marini Elena Gandossi Andrea Delbarba Ilenia Pirola Carlo Cappelli |
| author_facet | Virginia Maltese Elisa Gatta Irene Silvestrini Valentina Anelli Francesca Bambini Caterina Buoso Maria Cavadini Massimiliano Ugoccioni Maura Saullo Fiorella Marini Elena Gandossi Andrea Delbarba Ilenia Pirola Carlo Cappelli |
| author_sort | Virginia Maltese |
| collection | DOAJ |
| description | 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). |
| format | Article |
| id | doaj-art-9a865f5641254375bc70646cc85ca362 |
| institution | Kabale University |
| issn | 2090-651X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-9a865f5641254375bc70646cc85ca3622025-01-18T00:00:02ZengWileyCase Reports in Endocrinology2090-651X2025-01-01202510.1155/crie/6298137An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the BraveVirginia Maltese0Elisa Gatta1Irene Silvestrini2Valentina Anelli3Francesca Bambini4Caterina Buoso5Maria Cavadini6Massimiliano Ugoccioni7Maura Saullo8Fiorella Marini9Elena Gandossi10Andrea Delbarba11Ilenia Pirola12Carlo Cappelli13Department of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesSSD EndocrinologiaSSD EndocrinologiaSSD EndocrinologiaDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesDepartment of Clinical and Experimental SciencesGraves’ 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).http://dx.doi.org/10.1155/crie/6298137 |
| spellingShingle | Virginia Maltese Elisa Gatta Irene Silvestrini Valentina Anelli Francesca Bambini Caterina Buoso Maria Cavadini Massimiliano Ugoccioni Maura Saullo Fiorella Marini Elena Gandossi Andrea Delbarba Ilenia Pirola Carlo Cappelli An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave Case Reports in Endocrinology |
| title | An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave |
| title_full | An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave |
| title_fullStr | An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave |
| title_full_unstemmed | An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave |
| title_short | An Unusual and Severe Thyrotoxicosis in a Twin Pregnancy: Fortune Favors the Brave |
| title_sort | unusual and severe thyrotoxicosis in a twin pregnancy fortune favors the brave |
| url | http://dx.doi.org/10.1155/crie/6298137 |
| work_keys_str_mv | AT virginiamaltese anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT elisagatta anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT irenesilvestrini anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT valentinaanelli anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT francescabambini anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT caterinabuoso anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT mariacavadini anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT massimilianougoccioni anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT maurasaullo anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT fiorellamarini anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT elenagandossi anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT andreadelbarba anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT ileniapirola anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT carlocappelli anunusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT virginiamaltese unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT elisagatta unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT irenesilvestrini unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT valentinaanelli unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT francescabambini unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT caterinabuoso unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT mariacavadini unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT massimilianougoccioni unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT maurasaullo unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT fiorellamarini unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT elenagandossi unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT andreadelbarba unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT ileniapirola unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave AT carlocappelli unusualandseverethyrotoxicosisinatwinpregnancyfortunefavorsthebrave |