24 TRANSIENT REMISSION OF HYPERTHYROIDISM IN PREGNANCY

Abstract

A 17 y.o. girl had remissions of Graves' disease(GD)during 2 pregnancies. In the first, T4/FT4 fell on tapazole (TAP), from 21.4→13.0μg/dl and 3.31→ 0.9ng/dl resp., in 3 mons.T4 was normal off TAP from 6 wks before (BD) to 4 mons after delivery(AD)when it was 16.7μg/dl; TAP was restarted. During the second, antithyroid antimicrosomal antibodies (ATAB/AMAB)and TSH binding inhibiting immunoglobulin (Nichols, TBII) were also measured (below). T4, FT4 and T3 were normal off TAP for 4 mons BD to 5 mons AD when T4 was 13.9μg/dl and T3, 270ng/dl (60% RAI uptake). ATAB was positive throughout pregnancy until 9 mons AD when it was <1:10. AMAB fell to 1:400 4 mons AD, rising to 1:102,000 at 8 mons. TBII was normal for GD(13–16%). Fluctuations in autoimmune thyroid disease occurs in pregnancy; transient remissions are rare. This patient had 2 separate remissions late in pregnancy followed by relapses months later. AMAB changes occurred later than previously described and seemed to be timed with the second relapse. TBII and ATAB titers did not correlate with clinical disease.

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