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 hyperthyroidism. Upon further questioning in the emergency department, 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. Diagnostic 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
fluid 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 markedly 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 consistent 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