Mayer D C, Thorp J, Baucom D, Spielman F J
Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill 27599, USA.
Am J Perinatol. 1995 May;12(3):192-4. doi: 10.1055/s-2007-994450.
Untreated hyperthyroidism during pregnancy is associated with increased maternal and perinatal morbidity. Some features of this disease simulate preeclampsia, which may encourage delivery of the fetus. We report a case of poorly controlled hyperthyroidism associated with generalized seizures, where patient management was directed at a diagnosis of preeclampsia-eclampsia. Although the presence of eclampsia and marked hyperthyroidism is very rare, this case illustrates the importance of aggressive medical management of hyperthyroidism. A 17-year-old gravida was diagnosed with hyperthyroidism at 15 weeks' gestation. At 26 weeks' gestation, she was admitted to the hospital after noting edema of the upper and lower extremities, nausea, vomiting, shortness of breath, and a cough. At admission, she was hypertensive, tachycardic, and dyspneic. The patient was believed to have preeclampsia with pulmonary edema complicated by hyperthyroidism. We initiated magnesium sulfate therapy and administered several bolus doses of hydralazine, with little effect on blood pressure. Oliguria was noted, and a pulmonary artery catheter was inserted. Hours later, generalized seizure activity occurred, and a decision was made for abdominal delivery. Postoperatively, cardiovascular function stabilized. On postoperative day 3, we received the results of the thyroid function tests obtained at admission, which suggested a markedly hyperthyroid condition. Untreated or poorly treated hyperthyroidism may present a clinical picture similar to preeclampsia. In our case, both disease processes coexisted in their severest forms. It is possible, although completely unproven, that a relationship exists between poorly controlled hyperthyroidism and preeclampsia-eclampsia. More importantly, accurate diagnosis of hyperthyroidism should lead to prompt medical or surgical management, thereby decreasing maternal and perinatal morbidity.
孕期未治疗的甲状腺功能亢进与孕产妇及围产期发病率增加相关。该疾病的一些特征类似子痫前期，这可能促使胎儿娩出。我们报告一例甲状腺功能亢进控制不佳并伴有全身性癫痫发作的病例，在对该患者的管理中最初诊断为子痫前期 - 子痫。尽管子痫和明显的甲状腺功能亢进同时存在的情况非常罕见，但该病例说明了积极治疗甲状腺功能亢进的重要性。一名17岁孕妇在妊娠15周时被诊断为甲状腺功能亢进。妊娠26周时，她因注意到上下肢水肿、恶心、呕吐、呼吸急促和咳嗽而入院。入院时，她血压升高、心动过速且呼吸困难。患者被认为患有子痫前期合并肺水肿并伴有甲状腺功能亢进。我们开始使用硫酸镁治疗，并多次静脉注射肼屈嗪，但对血压影响不大。发现少尿后，插入了肺动脉导管。数小时后，发生全身性癫痫发作，于是决定行剖宫产。术后，心血管功能稳定。术后第3天，我们收到了入院时甲状腺功能检查的结果，结果提示甲状腺功能明显亢进。未治疗或治疗不佳的甲状腺功能亢进可能呈现与子痫前期相似的临床表现。在我们的病例中，两种疾病过程均以最严重的形式并存。虽然完全未经证实，但控制不佳的甲状腺功能亢进与子痫前期 - 子痫之间可能存在关联。更重要的是，准确诊断甲状腺功能亢进应促使及时进行药物或手术治疗，从而降低孕产妇及围产期发病率。
