Dr Hironobu Hyodo1, Dr Hinako Miyamoto1, Dr Aya Takeuchi1, Dr Yutaro Kubonoya1, Dr Satoshi Nitta1, Dr Midori Funakura1, Dr Shinya Imada1
1Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
Biography:
Graduated the University of Tokyo in 1994, and PhD degree in 2001. After physician in in the University of Tokyo Hospital, Nagano Children's Hospital and St. Luke's International Hospital,
Chief in 2013-2016, and Director since 2016, Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital
Abstract:
Hyperthyroidism is one of the common medical complications seen in women of reproductive age. Basedow’s disease may especially affect both the mother and the baby during pregnancy by autoimmune abnormality. Tachycardia, one of the typical symptoms of hyperthyroidism, may occur in pregnancy due to various effects of pregnancy and delivery. Here, we report a case in which postpartum tachycardia was confused with postpartum hemorrhage.
33y, G2P0, the pregnancy course had been uneventful until preterm premature rupture of the membrane on 36+1wk. The maternal heart rate had been over 120 bpm and the fetal heart rate had been over 160 throughout the labor but there was no sign of maternal infection, chorioamnionitis, or non-reassuring fetal status. A female baby was born in 2,718 g with the Apgar score of 9(1’)/9(5’). Total bleeding was counted less than 1 L but the maternal heart rate had been high and sometimes over 140 bpm overnight even with extra intravenous fluid. TSH was revealed less than the sensitivity and high free thyroxine two days after delivery, thus, she was diagnosed with hyperthyroidism and the TSH receptor antibody was positive. The baby was in good condition, and she had no symptoms of tachycardia, tachypnea or irritability although the low TSH and high free thyroxine.
Maternal hyperthyroidism may be sometimes caused by an autoimmune disorder and may affect not only the mother but also the baby by transferring maternal antibodies. Thyroid function screening in early pregnancy may be helpful, but, when tachycardia is more severe than that brought from the pregnancy itself or hemorrhage during delivery, hyperthyroidism should always be kept in mind.
Keywords
hyperthyroidism, tachycardia, postpartum hemorrhage