HYPERTHYROIDISM AND SEIZURES DURING PREGNANCY

Untreated hyperthyroidism during pregnancy is associated with increase d maternal and peri natal morbidity. Some features of th is disease si mu late preeclampsia, wh ich may encourage delivery of the fetus. We report a case of poorly controlled hyperthyroidism associated with gen eralized seizures, where patient management was directed at a diagnosi s of preeclampsia-eclampsia. Although the presence of eclampsia and ma rked hyperthyroidism is very rare, this case illustrates the importanc e of aggressive medical management of hyperthyroidism. A 17-year-old g ravida was diagnosed with hyperthyroidism at 15 weeks' gestation. At 2 6 weeks' gestation, she was admitted to the hospital after noting edem a of the upper and lower extremities, nausea, vomiting, shortness of b reath, and a cough. At admission, she was hypertensive, tachycardic, a nd dyspneic. The patient was believed to have preeclampsia with pulmon ary edema complicated by hyperthyroidism. We initiated magnesium sulfa te therapy and administered several bolus doses of hydralazine, with l ittle effect on blood pressure. Oliguria was noted, and a pulmonary ar tery catheter was inserted. Hours later, generalized seizure activity occurred, and a decision was made for abdominal delivery. Postoperativ ely, cardiovascular function stabilized. On postoperative day 3, we re ceived the results of the thyroid function tests obtained at admission , which suggested a markedly hyperthyroid condition. Untreated or poor ly treated hyperthyroidism may present a clinical picture similar to p reeclampsia. In our case, both disease processes coexisted in their se verest forms. It is possible, although completely unproven, that a rel ationship exists between poorly controlled hyperthyroidism and preecla mpsia-eclampsia. More importantly, accurate diagnosis of hyperthyroidi sm should lead to prompt medical or surgical management, thereby decre asing maternal and perinatal morbidity.