A resistant grave’s disease in pregnancy: Case report and review of the literature

Abstract

Background: Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. The effective management of Grave’s Disease (GD) during pregnancy is challenging for the clinician. The most common causes of hyperthyroidism are autoimmune GD and multinodular goiter. A 35 year old lady at 28 weeks of pregnancy, a case of Graves’ disease on anti-thyroid drug with uncontrolled thyrotoxic symptoms despite regular medication didn’t show clinical and biochemical normalization even with the maximum dose of antithyroid drug and antihypertensive drug permissible at pregnancy. At gestational week 28, T4 and T3 remained elevated with suppressed serum TSH and high levels of TSH receptor antibody levels. The patient had to be followed up medically with guarded prognosis. On follow up patient didn’t show any clinical or biochemical remission. Despite high thyroid hormones levels and higher anti-TSH receptor antibody levels all throughout the gestation and with maximum dose of PTU the patient delivered a healthy baby with no clinical symptoms of thyrotoxicosis, goitre or any stigmata of PTU in the neonate. Mother’s TFT was closed monitored and anti-thyroid medication was titred. We present a rare case of resistant GD in pregnancy, in different stages of pregnancy management encountered many challenges.