Thyroid Storm during Pregnancy; A Medical Emergency: Case Study 2 Janet Meadows
Jacksonville University

Thyroid Storm during Pregnancy; A Medical Emergency: Case Study 2 Objectives
Common signs and symptoms of hyperthyroidism
Effects of increased levels of thyroid hormones
Thyroid physiology during pregnancy
Grave’s disease
Thyroid storm
Background
Thyroid disease, is actually several different diseases, and affects approximately 6% of the population. Grave’s disease is the most common form of hyperthyroidism. Commons signs and symptoms include heat intolerance, excessive sweating, hypertension, tachycardia, goiter, nervousness, palpitations, and weight loss. Another common thyroid dysfunction is hypothyroidism. This is often seen as Hashimoto’s thyroiditis, which is a combination of both hyper and hypothyroidism. Signs and symptoms of hypothyroidism include cold intolerance, weight gain, constipation, hair loss, fatigue, and insomnia. Thyroid disease is common among women of childbearing age. Often times, these diseases are first discovered during pregnancy or during the postpartum period. Also, it may be difficult to diagnose as many normal changes associated with pregnancy may be confused with signs and symptoms of various diseases or just thought to be part of the normal progression of the pregnancy and the natural changes in a woman’s body due to hormones. Pregnant women who are diagnosed with hyperthyroidism require careful management to prevent complications that may lead to adverse effects for the mother and her unborn baby. A more serious and often life-threatening complication, thyroid storm, is seen more commonly in women that receive limited or no prenatal care and those that have medical or obstetric complications ("National Institute of Health," 2012).

History and Physical
Beth is a 35 year old Caucasian G1P0 woman approximately 28 weeks gestation. She has no history of any medical complications or previous surgeries. She was seen for her first prenatal visit around 14 weeks gestation but has had not follow up prenatal care since she and her husband have recently moved to a new town. Beth has been feeling very nervous and jittery and not sleeping well. She and her husband have blown it off as stress from pregnancy, the move, and a recent bout with the flu. However, today, Tom, Beth’s husband, noticed that she was remarkably confused and disoriented. She was complaining of shortness of breath and stated that her heart felt as if it were ‘racing’. When Tom tried to lead her to sit down, he noticed she was very hot and sweaty. He immediately brought her into the local emergency room for evaluation. On physical examination it was indicated that her body temperature, pulse rate, respirations, and blood pressure were all above normal limits. It was also noticed that she has a goitrous thyroid gland, mild bilateral exophthalmos, and confusion. Due to these findings the emergency room physician ordered thyroid function testing and a fetal ultrasound. Laboratory/Diagnostic Findings

Labs uncover an elevated level of free thyroxine, a decreased level of thyroid-stimulating hormone, and a high l...

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