Autoimmune Implications in a Patient with Graves’ Hyperthyroidism, Pre-eclampsia with Severe Features, and Primary Aldosteronism
Abstract
:1. Introduction
2. Detailed Case Description
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Date | Symptoms and Signs Clinical Status | TSH (0.45–5.33 μIU/mL) 1 | Free T4 (0.58–1.64 ng/dL) 1 | Free T3 (2.50–3.90 pg/mL) 1 | TSI 2 (<140%) | Thyroid Treatment |
---|---|---|---|---|---|---|
30 Jun | Tremulousness, overheated, racing heart; 17 weeks pregnant | 0 | 0.89 | 4.7 | 163%; TSH Receptor Antibodies negative | none |
8 Jul | 0 | 0.7 | 4.61 | |||
30 Aug | 0.03 | 0.5 | 4.03 | |||
12 Sep | Thyroid sonogram: no nodules | |||||
1 Oct | Oral glucose tolerance test positive for gestational diabetes; treated with diet and later insulin | 0.04 | 0.47 | 3.57 | 102% | |
27 Oct | 3 Preeclampsia with severe features; Cesarean delivery 34 4/7 weeks; male, 4.080 kg, Apgar 8, 9; gestational diabetes resolved 6 weeks postpartum | |||||
12 Jan | 2.1 | 0.9 | ||||
15 May | Emergency room for paresthesia and weakness of right arm, BP 169/98, pulse 97 | 0 | 3.93 | 14.62 | 121% | Started: Methimazole: 10mg 3x/day, Metoprolol: 25mg 2x/day, Dexamethasone: 1mg, 2x/day × 7days |
31 May | 0 | 1.75 | 4.94 | |||
6 Jun | Rash | 0 | 1.26 | 5.61 | Stopped: Methimazole | |
20 Jun | 0 | 2.24 | 10.03 | 124% | ||
25 Jul | 0 | 3.42 | 13.8 | TSH Receptor Antibodies negative | Dexamethasone 1mg, 2x/day × 7days | |
12 Aug | Diffuse follicular hyperplastic changes with patchy mild chronic thyroiditis on pathology; pathological diagnosis, Graves’ Disease | Thyroidectomy, Started: Levothyroxine 125mcg/day | ||||
31 Aug | 0.01 | 0.87 | 3.98 | Levothyroxine 125mcg/day |
Date | BP and Potassium (meq/L) 1 | Medications and Clinical Status | Aldosterone/Renin Ratio (ARR) (ng/dL)/(ng/mL/h) 2 |
---|---|---|---|
30 Jun | 124/62 | none | |
27 Oct | (164–177)/(84–102) | 3 Preeclampsia with severe features; Delivery | |
12 Jan | 140/90 | Lisinopril Hydrochlorothiazide | |
15 May | 169/98 Potassium 2.5 | Lisinopril Hydrochlorothiazide Added: Hydralazine and Potassium Chloride | |
25 May 31 May | Potassium 2.7 Potassium 3.2 | 13/0.06 = 216.7 9/0.07 = 128.6 | |
6 Jun | 162/90 | Started: Spironolactone: 50mg 1x/day, three days later increased 2xday. Stopped: Potassium Chloride and BP medications | |
13 Jun | 118 systolic by palpation | ||
20 Jun | 124/76 Potassium 3.6 | ||
25 Jul | 130/74 | ||
12 Aug | 130/80 | Thyroidectomy Started: Levothyroxine | |
22 Aug | 160s/100–110 Potassium 3.2 | Patient had stopped spironolactone. It was restarted, 50mg 2x/day | Patient had discontinued spironolactone for 10 days. Repeat A/R: 6/0.25 = 24.0 |
31 Aug | 130/74 Potassium 4.2 | Spironolactone, 50mg, 2x/day |
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Lin, B.; Robinson, L.; Soliman, B.; Gulizia, J.; Usala, S. Autoimmune Implications in a Patient with Graves’ Hyperthyroidism, Pre-eclampsia with Severe Features, and Primary Aldosteronism. Medicina 2024, 60, 170. https://doi.org/10.3390/medicina60010170
Lin B, Robinson L, Soliman B, Gulizia J, Usala S. Autoimmune Implications in a Patient with Graves’ Hyperthyroidism, Pre-eclampsia with Severe Features, and Primary Aldosteronism. Medicina. 2024; 60(1):170. https://doi.org/10.3390/medicina60010170
Chicago/Turabian StyleLin, Benjamin, Lauren Robinson, Basem Soliman, Jill Gulizia, and Stephen Usala. 2024. "Autoimmune Implications in a Patient with Graves’ Hyperthyroidism, Pre-eclampsia with Severe Features, and Primary Aldosteronism" Medicina 60, no. 1: 170. https://doi.org/10.3390/medicina60010170