Graves Disease: Successful Cesarean Section and Salpingectomy

Abstract

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 hyper
thyroidism. Upon further questioning in the emergency depart
ment, 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. Diagnos
tic testing including assessment of thyroid stimulating hormone 
(TSH) and anti-thyroid peroxidase (anti-TPO) antibodies proved 
to be inconclusive due to high-levels of fluctuation. Further testing 
to confirm the degree of hyperthyroidism was then considered. A 
nuclear medicine thyroid uptake scan was performed after the risks 
and benefits were discussed with the patient. To reduce the risk for 
the fetus, the patient was advised to increase fluid intake. Increased 
f
 luid intake and increased urine output significantly reduces the risk 
of fetal exposure to radioactive material.1 Administration of 302 
unique client identifier (UCI) of I-123 Isotope was administered 
and thyroid uptake was measured. Five-hours after administration, 
thyroid uptake was 63.8% and at 23-hours was 67.1%, both mark
edly 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 radiologic impression significantly increased 
the isotope uptake at both 5-hours and 23-hours that is consis
tent with the graves disease. After the detailed discussion about 
the probable results with the patient, high-risk obstetric surgery 
was planned. A low transverse C-section was performed along with 
bilateral salpingectomy. 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 in
house 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