ABSTRACT
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.
Keywords
Hyperthyroidism - pregnancy - perinatal morbidity - seizures
