Thyroid Crisis and Septic Suspected Sepsis in the First Trimester of Pregnancy

Authors

  • Mahmudah Hidayati Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
  • Banundari Rachmawati Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

DOI:

https://doi.org/10.24293/ijcpml.v26i3.1535

Keywords:

Pregnancy, hyperthyroidism, thyroid crisis, sepsis

Abstract

A normal pregnancy with physiological and hormonal changes can change thyroid function, accordingly, there are difficulties to establish the diagnosis of thyroid abnormality. The prevalence of hyperthyroidism in pregnancy is 0.6%. Approximately 1-2% of hyperthyroidism develops into a thyroid crisis. Knowledge of the diagnosis of the thyroid crisis in a pregnant female is very important to avoid complications. The 22-year-old female of thirteen weeks presented with vomiting, since two days before hospitalized, weakness, and decreased consciousness. During treatment, patients had diarrhea, melena, and was irritable. Physical examination showed blood pressure of 136/112 mmHg, pulse of 110 times/minute, respiration of 24 times/minute, and temperature of 38.3oC. Exophthalmos was found at the patient's eyes, but there was no enlargement of the thyroid and the patient often screamed hysterically. Routine urine examination showed proteinuria 1+, blood 3+, leukocytes 1+ in urinalysis, FT4 35.18 pmol/L and TSH <0.05 uIU/mL, leukocytes 15.2 x103/uL, SGOT 245 U/L, SGPT 366 U/L. The final diagnosis of this patient is a thyroid crisis and suspect sepsis in the first trimester of pregnancy. Thyroid Receptor Antibody (TRAb) examination should be performed to assure Graves disease or hyperthyroidism due to pregnancy (transient hyperthyroidism) as the cause.

Downloads

Download data is not yet available.

Author Biographies

Mahmudah Hidayati, Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

Banundari Rachmawati, Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

References

Fujiko M. Hipertiroid dalam kehamilan. Divisi Fetomaternal, Departemen Obgin FK UNHAS/ RS Dr.Wahidin Sudirohusodo. Makassar. 2016

Shomon M. Symptoms of Hyperthyroidism. Agustus 2018. www.verywellhealth.com

Andersen SL, Olsen J, Carlé A, Laurberg P. Hyperthyroidism Incidence Fluctuates Widely in and Around Pregnancy and Is at Variance With Some Other Autoimmune Diseases : A Danish Population-Based Study. 2018;100(March 2015):1164–71.

Thobbi VA, Majeed S. Prevalence of Thyroid Disorder in Pregnancy. Int J Tech Res Appl. 2016;4(2):2320–8163.

American Thyroid Association. Pregnancy and Thyroid Disease. 2017. WWW. Thyroid.org

Newson L. Hyperthyroidism in Pregnancy. 23 Desember 2015

Newson L. Hyperthyroid Crisis. 2015

Yeh C-Y, Yu W-L. A case report of thyroid storm induced by acute sepsis. J Acute Dis. 2016;5(2):160–1

Moore K. Thyroid Storm: Causes, Symptoms, and Diagnosis. Healthline. 2017. https://www.healthline.com

Sheehan PM, Nankervis A, Júnior EA, Da F, Costa S. Maternal Thyroid Disease and Preterm Birth : Systematic Review and Meta-Analysis. 2018;100(July):4325–31.

Aggarwal R, Chugh P. Management of hyperthyroidism in pregnancy. 2016;5(1):1–5

Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev.1997; 18(3):404–433.

Williamson R, McLaren J, Beckett G, Forbes S & Brown R. Guidelines for The Management of Thyrotoxicosis. May 2014

Suhartoyo T. Krisis Tiroid. Sendomet 2018. Semarang: Penerbit PAPDI Semarang.

Wei C, Myint AA. Hyperemesis gravidarum and gestational transient hyperthyroidism : A case report. 2013;1(2):7–10.

NICE Guidline. Sepsis : recognition , diagnosis and early management. 2018;(July 2016)

Spapen HD, Jacobs R, Honore PM. Sepsis Induced multi Organ Dysfunction Syndrome-a Mechanistic Approach. J Emerg &Crit Care Med. 2017;1:2

Downloads

Submitted

2019-07-22

Accepted

2019-08-19

Published

2020-09-30

How to Cite

[1]
Hidayati, M. and Rachmawati, B. 2020. Thyroid Crisis and Septic Suspected Sepsis in the First Trimester of Pregnancy. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 26, 3 (Sep. 2020). DOI:https://doi.org/10.24293/ijcpml.v26i3.1535.

Issue

Section

Case Report