Graves Disease: Successful Cesarean Section and Salpingectomy.
A 41-year-old G2P1001 female patient was presented to the emergency department at 37-weeks of gestation with a prior history of non-compliance, uncontrolled hypertension and hyperthyroidism. Upon further questioning in the emergency department, the patient reported for a cesarean section (C-section) and bilateral salpingectomy for permanent sterilization and she was not taking her medications for her comorbid conditions. Further testing to confirm the degree of hyperthyroidism was then considered. To reduce the risk for the fetus, the patient was advised to increase fluid intake. Increased fluid intake and increased urine output significantly reduces the risk of fetal exposure to radioactive material.
Five-hours after administration, thyroid uptake was 63.8% and at 23-hours was 67.1%, both markedly increased. The normal uptake for these studies is 7-20% at 6-hours and 10-35% at 24-hours. As illustrated in Figure 1, the scan shows uniform isotope uptake evident of the right and left
lobes of the thyroid gland with no focal areas of decreased or increased uptake.
The patient tolerated the procedure well with no anesthetic complications. Upon the birth of the neonate, there were no complications reported after assessment by an inhouse neonatologist. Thus, making this high-risk surgery a success. Graves disease affects 1 out of every 1000 women and the unique steps taken during this case has made it successful and noteworthy.
Despite the patient’s history of hyperthyroidism disease, she had no reported complications during any previous pregnancies. Given the fact that poorly controlled thyrotoxicosis is related to several maternal and fetal complications, it is crucial to achieve euthyroidism rapidly.
Women Health Open J. 2020; 6(1): 1-2.doi: 10.17140/WHOJ-6-134