Diagnostics
The main symptoms of the patient are sensitive palpitations, excessive sweating, constant nervousness, and anxiety. Also, there are frequent mood changes, weakness, depression, and protrusion of the eyes, which point to the fact that she has hyperthyroidism. It is a common hormonal disease caused by an increase in thyroid function when the corresponding organ increases in size and produces a large number of thyroid hormones – T3 triiodothyronine and T4 thyroxin (Cooper & Laurberg, 2013). Pathophysiology of hyperthyroidism may be explained by the level of T3 that is usually higher than that of T4, which is associated with enhanced secretion of T3 as well as the conversion of T4 to T3 in peripheral tissues.
The cause of thyroid activation in The patient may be an increased level of partially deserialized hCG, which stimulates the thyroid gland more than the normal hormone. Sometimes, hyperthyroidism in pregnant women is a temporary phenomenon, and after childbirth, the normal function of the thyroid gland is restored (Cooper & Laurberg, 2013). In this patient, the increased heart rate and palpitations may be explained by the sensitivity of the sympathetic nervous system and cardiac receptors to T3.
The experimental study shows that in hyperthyroidism, the increased sensitivity of the sympathoadrenal system may be viewed, which is mediated by a boost in the number of β-adrenergic receptors and guanine nucleotide-regulating protein (Mullur, Liu, & Brent, 2014). β -adrenoreceptors increase by almost two times in the sinus-atrial node compared with the surrounding myocytes, among which β -1 receptors prevail. In the cardiac tissue, the β -1 adrenergic receptor gene is assumed to be T3 sensitive, while the β -2 receptor gene is under the minimal influence.
There are several groups of pathological conditions that are manifested by the increased synthesis and release of thyroid hormones in pregnant women. Only in 8-10 percent of patients, the etiology of hyperthyroidism is associated with physiological processes occurring during gestation and after childbirth (Korelitz et al., 2013). In other cases, the level of thyroxine and triiodothyronine rises due to diseases that occurred before pregnancy. The main etiological factors are hyperstimulation of thyrotropin receptors and high levels of iodine in the blood. In the case of the given patient, it is possible to assume that her disease is transactional since she had no similar symptoms before pregnancy.
Management
The choice of drugs for the treatment of hyperthyroidism in pregnant women is determined by the causes of the disorder. The main difficulty of therapy is the inability to use products containing radioactive iodine during pregnancy. The patient may be prescribed antithyroid drugs – thermostatic – that work by blocking thyroid peroxidase, preventing the organization of iodides, and inhibiting the peripheral conversion of thyroxine to triiodothyronine.
This method allows quickly improving the condition of patients and monitoring their progress. At the same time, β-blockers will be useful to eliminate the effects of adrenergic stimulation that occurred on the background of hyperthyroidism. Namely, tachycardia, rhythm disturbances, emotional disorders, heat intolerance, and eye protrusion will be addressed.
As a patient with transient subclinical thyrotoxicosis, The patient needs constant monitoring with regular laboratory tests. With proper treatment, pregnancy ends in the birth of a healthy child in the majority of cases, as reported by Cooper and Laurberg (2013). The frequency of preterm and spontaneous abortions is the same as in the absence of hyperthyroidism. The preferred method of delivery is natural childbirth with adequate analgesia along with monitoring of a fetus and hemodynamic parameters.
References
Cooper, D. S., & Laurberg, P. (2013). Hyperthyroidism in pregnancy. The Lancet Diabetes & Endocrinology, 1(3), 238-249.
Korelitz, J. J., McNally, D. L., Masters, M. N., Li, S. X., Xu, Y., & Rivkees, S. A. (2013). Prevalence of thyrotoxicosis, antithyroid medication use, and complications among pregnant women in the United States. Thyroid, 23(6), 758-765.
Mullur, R., Liu, Y. Y., & Brent, G. A. (2014). Thyroid hormone regulation of metabolism. Physiological Reviews, 94(2), 355-382.