Thyroid dysfunction during severe ovarian hyperstimulation syndrome. A case report.

Thyroid disorders, both in women who wish to conceive and in gravidas, has become a topic of much interest to numerous researchers. Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening condition among women undergoing controlled ovarian hyperstimulation (COH). We present a case of thyroid dysfunction in severe OHSS in a patient diagnosed with subclinical hypothyroidism before COH. The dose of L-thyroxine (L-T4) was increased before the procedure in order to reach TSH levels below 2.5 mU/L, and from day 1 of the stimulation the dose of L-T4 was increased by 33%. The patient remained clinically and biochemically euthyroid until day 8 after the embriotransfer (ET). Then, the woman developed severe OHSS, with fluid in the pleural and peritoneal cavity and laboratory evidence of severe OHSS. Laboratory thyroid function tests revealed overt hypothyroidism. L-T4 dose was not increased due to serious clinical condition of the patient. Iodine supplementation was initiated instead. After the symptoms subsided, a period of clinical and laboratory euthyroid state was observed, followed by gestational hyperthyroidism. The L-T4 dose was reduced and iodine supplementation was temporarily ceased. The thyroid function stabilized, while maintaining the L-T4 and iodine supplementation, at 20 weeks of gestation. The patient gave birth by a caesarean section at 37 weeks of gestation and returned to the pre-pregnancy dose of L-T4. To the best of our knowledge, this has been the first report about a patient with thyroid dysfunction in severe OHSS in the Polish literature. On the basis of the presented case and a review of the literature on thyroid dysfunction in women undergoing COH and OHSS, we conclude that clinical signs and biochemical parameters need to be taken into consideration while making therapeutic decision in women with thyroid dysfunction in the course of OHSS. Also, further studies are necessary to elucidate the matter.

[The value of a urine protein-to-creatinine ratio assessment in a single voided urine specimen in prediction of 24-hour proteinuria in pregnancy induced hypertension]. / Wartosc oznaczania wspólczynnika bialko/kreatynina w pojedynczej próbce moczu w prognozie bialkomoczu dobowego u pacjentek z nadcisnieniem indukowanym ciaza.

OBJECTIVES: Detecting proteinuria is an integral part in management of hypertensive pregnant women. The measurement of protein excretion in a 24-hour urine collection is used as the gold standard for the diagnosis and follow-up of pathologic urinary excretion. However, 24-hour urine collection is time consuming, cumbersome and often inaccurate especially during pregnancy. Pregnant women find it very inconvenient and difficult. AIM: The study was undertaken to validate the prediction of 24-hour protein excretion by a single voided urine protein-to-creatinine ratio in hospitalized hypertensive pregnant women. MATERIAL AND METHODS: The study was performed in the Pregnancy Pathology Ward, City Hospital in Gdynia in 2002-2004. Pregnant women at > or = 20 weeks with hypertension (blood pressure > or = 140/90 mmHg) with proteinuria at initial urine examination were evaluated. A protein-to-creatinine ratio was obtained from first voided urine sample next morning and then urine was collected for next 24 hours for measurement of protein excretion. RESULTS: 44 women were evaluated. A total of 56 cases of the 24-hour urine collection were analyzed. There is a close correlation between the protein-to-creatinine ratio in random urine samples and the 24-hour protein excretion measured by 24-hour urine collection. Pearson correlation coefficient R=0,85 (P<0,001, R2= 0,73). A protein-to-creatinine ratio < 0,2 (g/g) can rule out significant proteinuria (defined as 24-hour urinary protein excretion > 300 mg) with sensitivity 92,0%, specificity 90,32%, positive predictive value 88,46%, negative predictive value 93,33%. CONCLUSIONS: The protein-to-creatinine ratio of a single urine sample correlate with the 24-hour urine protein excretion. A protein-to-creatinine ratio < 0,2 (g/g) can rule out significant proteinuria.

[A 25-week cervical pregnancy, complicated by extensive hemorrhage and terminated by cesarean section followed by hysterectomy and birth of a child]. / 25-tygodniowa ciaza szyjkowa, powiklana masywnym krwotokiem, zakonczona cieciem cesarskim z nastepowa histerectomia oraz urodzeniem zywego noworodka.

This is a case report of 32-year-old woman, primigravida, admitted to our department in 25th week of undiagnosed cervical pregnancy complicated by extensive, painless vaginal bleeding. The patient underwent a caesarean section followed by hysterectomy with the preservation of the ovaries, this being due to a life-threatening hemorrhage and abnormal placental location. A live female child was born. The woman was discharged after a 7 day of uneventful postoperative stay. After a 4-month treatment the baby was discharged in a good general condition, but required subsequent management of retinopathy of prematurity.