Transient Hyperthyroidism of Hyperemesis Gravidarum: A Case Report from Rural Kenya
DOI:
https://doi.org/10.47672/ejhs.1803Keywords:
Hyperthyroidism Pregnancy, Hyperemesis Gravidarum, Transient Hyperthyroidism Hyperemesis Gravidarum, THHG, KenyaAbstract
Purpose: The aim of the study was to assess the transient hyperthyroidism of hyperemesis gravidarum: A case report from rural Kenya.
Materials and Methods: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.
Findings: Hyperthyroidism complicates 0.2-0.4% of pregnancies. It may be diagnosed in the setting of hyperemesis gravidarum and can be pathological or transient. Untreated pathological hyperthyroidism has adverse maternal and fetal outcomes. Transient hyperthyroidism of hyperemesis gravidarum (THHG) affects up to 60% of women with hyperemesis, is self-limiting, and needs no antithyroid drug treatment. A diagnosis of THHG (rather than overt pathological hyperthyroidism) should be made when hyperthyroidism occurs in the setting of hyperemesis gravidarum and in the absence of pre-pregnancy hyperthyroidism, clinical findings compatible with maternal hyperthyroidism, and a negative antithyroid autoimmune profile. THHG resolves by the end of the first trimester without adverse pregnancy outcomes. We present a case from a rural Kenyan hospital to highlight the clinical profile and management of THHG for the primary care physician.
Implications to Theory, Practice and Policy: Assessment of thyroid functions is indicated in hyperemesis gravidarum, where there are clinical features of hyperthyroidism. THHG is a self-limiting benign condition that may inappropriately lead to unnecessary drug treatment for pathological hyperthyroidism in pregnancy. A diagnosis of THHG should be made when a laboratory picture of hyperthyroidism occurs in the setting of hyperemesis gravidarum in the absence of pre-pregnancy hyperthyroidism, compatible physical findings, and a negative antithyroid autoantibody profile.
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(1) Jennings LK, Mahdy H. Hyperemesis Gravidarum. StatPearls. Treasure Island (FL): StatPearls Publishing
(2) Copyright © 2024, StatPearls Publishing LLC.; 2024.
(3) Kimura M, Amino N, Tamaki H, Ito E, Mitsuda N, Miyai K, et al. Gestational thyrotoxicosis and hyperemesis gravidarum: possible role of hCG with higher stimulating activity. Clin Endocrinol (Oxf). 1993;38(4):345-50.
(4) Fejzo MS, Sazonova OV, Sathirapongsasuti JF, HallgrÃmsdóttir IB, Vacic V, MacGibbon KW, et al. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nat Commun. 2018;9(1):1178.
(5) Altuwaijri M. Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review. Medicine (Baltimore). 2022;101(35):e30487.
(6) Zimmerman CF, Ilstad-Minnihan AB, Bruggeman BS, Bruggeman BJ, Dayton KJ, Joseph N, et al. Thyroid Storm Caused by Hyperemesis Gravidarum. AACE Clin Case Rep. 2022;8(3):124-7.
(7) Koulouri O, Gurnell M. How to interpret thyroid function tests. Clin Med (Lond). 2013;13(3):282-6.
(8) Dulek H, Vural F, Aka N, Zengin S. The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester. North Clin Istanb. 2019;6(3):267-72.
(9) Lo JC, Rivkees SA, Chandra M, Gonzalez JR, Korelitz JJ, Kuzniewicz MW. Gestational thyrotoxicosis, antithyroid drug use and neonatal outcomes within an integrated healthcare delivery system. Thyroid. 2015;25(6):698-705.
(10) Ain KB, Mori Y, Refetoff S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialylation: a mechanism for estrogen-induced elevation of serum TBG concentration. J Clin Endocrinol Metab. 1987;65(4):689-96.
(11) Ballabio M, Poshychinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991;73(4):824-31.
(12) Villavicencio CA, Franco-Akel A, Belokovskaya R. Gestational Transient Thyrotoxicosis Complicated by Thyroid Storm in a Patient With Hyperemesis Gravidarum. JCEM Case Reports. 2023;1(3).
(13) Farshbaf-Khalili A, Salehi-Pourmehr H, Najafipour F, Alamdari NM, Pourzeinali S, Ainehchi N. Is hyperemesis gravidarum associated with transient hyperthyroidism? A systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2023;62(2):205-25.
(14) Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022;18(3):158-71.
(15) Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Arch Gynecol Obstet. 2011;283(2):243-7.
(16) Ehlers M, Schott M, Allelein S. Graves' disease in clinical perspective. Front Biosci (Landmark Ed). 2019;24(1):35-47.
(17) Caffrey TJ. Transient hyperthyroidism of hyperemesis gravidarum: a sheep in wolf's clothing. J Am Board Fam Pract. 2000;13(1):35-8.
(18) McNeil AR, Stanford PE. Reporting Thyroid Function Tests in Pregnancy. Clin Biochem Rev. 2015;36(4):109-26.
(19) Tan JY, Loh KC, Yeo GS, Chee YC. Transient hyperthyroidism of hyperemesis gravidarum. Bjog. 2002;109(6):683-8.
(20) Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020;135(6):e261-e74.
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Copyright (c) 2024 Vonwicks C. Onyango, Collins P. Malalu, William C. Fryda
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