Observational Study
Copyright ©The Author(s) 2019.
World J Clin Cases. Oct 6, 2019; 7(19): 2953-2962
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.2953
Table 2 Clinical course of six pregnant patients with hyperthyroid heart disease
PatientClinical course
1No antenatal care. Previous history: Diagnosed with Graves’s disease at age 12 and treated with antithyroid treatment till 16. Lower extremity edema for 3 mo, and palpitations and heat intolerance for 3 wk. No fetal movement for 1 day, and regular uterine contraction for 12 h. Altered level of consciousness after admission, oxygen was immediately administered via a facemask, recovered to consciousness. Artificial rupture of membranes and Willett-Martel scalp flap forceps were used to deliver the fetus. Transferred to ICU after delivery. 5 times of acute heart failure attacks in 3 d after delivery. Except for normal approach, CRRT and NIPPV were applied. Blood plasma and albumin were given. After reaching a stable situation, she was discharged at day 7 at patients request. Follow-up: Conservative treatment in local hospital for a month after delivery. I131 treatment one year after delivery, recovered well. Normal thyroid function at follow-up
2Irregular antenatal care in local hospital. Previous history: Diagnosed with Graves’s disease at 14, irregular treatment with ATD therapy 2 yr before, stopped treatment during pregnancy. Cough with phlegm for 10 d, and generalized edema, dyspnea, and palpitations for 3 d. Treatments included PTU, propranolol, and antibiotics. Magnesium sulfate was used for pree-clampsia, and blood transfusion was applied for anaemia. Onset of labour at her 35 + 5 wk. Presented with symptoms and signs of heart failure during the second stage of labour, digoxin injection, furosemide, and oxygen mask were administered immediately to arrest heart failure, and continuous intra-venous pumping of nitroglycerin was used to control high blood pressure. Gave birth vaginally with the assistance of vacuum to a female baby weigh-ing 2010 g, Apgar 7-8-9. Admitted to NICU. Discharged at day 9. Follow-up: Chest radiography revealed small patchy consolidation in low lobes of right lung two days after delivery. Chest radiography returned to normal 6 wk after delivery, but thyroid function test still showed high levels of T3 and T4. Used ATDs regularly and had thyroid function test every half year. Normal thyroid function and stopped ATD treatment 5 yr after delivery
3Irregular antenatal care in local hospital. Never been diagnosed as hyperthyroidism. Previous history: Accepted blood transfusion 1 mo before in local hospital. Generalized edema for 1 month, and cough, orthopnea, and dyspnea for 4 d. Treatments included PTU, propranolol, antibiotics, furose-mide, magnesium, and dexamethasone. Gave birth vaginally at her 36 wk to a female baby weighing 2080 g, Apgar 9-10-10. Discharged at day 12. Follow-up: Chest radiography returned to normal 6 wk after delivery. Used ATDs for one year after delivery, then thyroid function test returned to normal
4Regular antenatal care in local hospital. Diagnosed with Graves’s disease at local hospital at 14 wk. PTU was applied after diagnosis. Previous history: Treated with PTU, propranolol, magnesium sulfate, and antibiotics at local hospital for a week. Lower extremity edema for 1 mo, and anxiety and palpitations for 2 wk. Enlargement of left atrium and atrial fibrillation was found in local hospital without appropriate treatment. Increased vaginal discharge and suspected premature rupture of membrane for 1 wk, and dyspnea and orthopnea for 2 d. Treatments included increased dose of PTU, propranolol, more potent antibiotics, frusemide, and magnesium sulfate. Regular monitoring included blood white cell count, C-reactive protein, procalcitonin, and vaginal secretion culture. Gave birth vaginally to a male baby at her 33 + 2 wk weighing 2220 g, Apgar 10-10-10. Admitted to NICU. Discharged at day 20. Follow-up: Chest radiography returned to normal 6 wk after delivery. Used ATDs and had thyroid function test regularly, and used MMI 5 mg per day
5Regular antenatal care. Previous history: Diagnosed with Graves’s disease for loss of weight and exophthalmos 2 mo before pregnancy, then regularly treated with ATDs. Cough with phlegm, dyspnea, and palpitations at 34 wk. Enlarged left atrium was found. Hospitalization treatments included antibiotics, PTU, propranolol, and magnesium sulfate for 10 d. Cough and moderate palpitations for 2 d. Treatments included MMI and antibiotics. A female baby weighing 3360 g was delivered by caesarean section at her 39 + 4 wk, Apgar 10-10-10. Discharged at day 8. Lost to follow-up
6Regular antenatal care at local hospital. Previous history: Diagnosed with Graves’s disease at age 22, RAI therapy at 24, and continuous treatment with ATD. Moderate palpitations for 3 mo, cough and heart intolerance for 3 d, and rupture of membrane for 6 h. Treatment included PTU. A female baby weighing 3860 g was delivered by caesarean section at her 39 wk, Apgar 10-10-10. Discharged at day 6. Follow-up: Echocardiography showed only enlarged left ventricle and normal EF six days after delivery. Normal chest radiography and normal thyroid function 6 wk after delivery