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Wedanta Mahadewi, I Gusti Agung
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Decision Sciences, Operations Research & Management Earth & Planetary Sciences Economics, Econometrics & Finance Education Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Mathematics Nursing Social Sciences

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Journal : International Journal of Advanced Multidisciplinary

 1 
Thyrotoxicosis in Partial Mola Hidatidosa Wedanta Mahadewi, I Gusti Agung; Purwa Sunu, Arya Baruna; Adisastra, Suryantha
International Journal of Advanced Multidisciplinary Vol. 3 No. 1 (2024): International Journal of Advanced Multidisciplinary (April-June 2024)
Publisher : Green Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/ijam.v3i1.539

Abstract

Thyrotoxicosis is a clinical condition associated with excessive thyroid hormone levels. Symptoms can range from asymptomatic to life-threatening due to thyroid storm. Thyrotoxicosis in hydatidiform moles is a rare condition but has a high mortality rate, so etiological studies are still needed for optimal management. Case Report: Patient Mrs. T, 25 years old Hindu, Balinese, 12 weeks pregnant (Gravida 1 Para 0 abortion 0), came to the obstetrics ER on September 24, 2023 with complaints of discharge from the birth canal since the morning, nausea (+), often shaking, easily tired and often sweaty. physical examination obtained blood pressure 100/60mmHg, pulse 78x/min, respiratory rate 20x/min, axillary temperature 36.80C oxygen saturation 99%. From obstetric examination, fundus uteri height ½ center, vaginal toucher vulva vagina within normal limits, portiono (-) fluxus (+), laboratory examination obtained HCG 387,392.8 mIU/m, FT4 31.05 pmol/L (N: 9-22), TSH <0.01 uIU/mL (N: 0.4-4.2) ultrasound results describe honey comb appearance and histopathology results describe partial mola.  Evacuation by curettage was performed, resulting in reduced serum ?-hCG levels and reduced thyroid hormone levels. Discussion: The patient was diagnosed with partial hydatidiform mole and thyrotoxicosis. Hydatidiform moles can cause thyrotoxicosis. This condition is caused by the structure of ?- hCG which resembles TSH so that it can activate TSH receptors.  After evacuation of hydatidiform moles, normal TSH and FT4 levels will be obtained. Conclusion: The female patient with thyrotoxicosis due to hydatidiform moles had the moles evacuated, resulting in normal thyroid hormone levels.
Co-Incidence of Diabetic Ketoacidosis and Thyroid Crisis at Klungkung Regional General Hospital Wedanta Mahadewi, I Gusti Agung; Putri Purnama Dewi, Ni Made
International Journal of Advanced Multidisciplinary Vol. 3 No. 1 (2024): International Journal of Advanced Multidisciplinary (April-June 2024)
Publisher : Green Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/ijam.v3i1.552

Abstract

Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus characterized by uncontrolled of hyperglycemia, metabolic acidosis and increased ketone concentrations in the body. Thyroid crisis is one of the acute and life-threatening complications of hyperthyroidism where the symptoms involve multi-organ systems. The coincidence of DKA with Thyroid Crisis is rare and the pathophysiology of this coincidence is not well known and is still widely debated. Early recognizing and managing both emergencies will improve the success of patient management. In these case report there is a coincident of DKA and thyroid crisis at Klungkung Regional General Hospital. Case Report: KS, female, 57 years old came to the emergency room of RSUD Klungkung with the main complaint of nausea and vomiting accompanied by shortness of breath, cough with yellow phlegm and fever since 5 days ago. Other complaints were weakness, dizziness, and palpitations. The patient has a history of DM since 3 years ago and is routinely treated using basal and prandial insulin. Thyroid disease was known since 6 months ago and routinely took Tiamazol, but since 5 days ago the patient stopped the medication because he felt weak and ate little because of complaints of nausea and vomiting with concerns that blood sugar was falling. On examination of vital signs the patient appeared very ill, consciousness E3V4M6 appeared agitated. Blood pressure 130/80 mmHg, pulse 102x/min. Respiratory rate 28x/min seemed fast and deep breaths, axillary temperature 390C with oxygen saturation 89% room temperature and 98% with oxygen 4 liters per minute nasal cannul. On auscultation of the lungs, coarse rhonki sound in the right and left paracardial confirms the clinical pneumonia. On laboratory examination, hyperglycemia was found, with blood glucose (BS) 456mg/dL, urinalysis results obtained ketones +3 and glucose +3. The results of blood gas and electrolyte analysis showed metabolic acidosis at pH 7.17, PCO2 19.0mmHg, HCO3- 7.0 mmol/L, BE (B) -22mmol/L and Potassium 5.4mmol/L. FT4 was 29.87 pmol/L and TSH <0.10 uIU/mL with a Burch Wartofsky score of 55 supporting the diagnosis of thyroid crisis. The patient was admitted to the intensive care unit with the management of hydration to overcome fluid and electrolyte balance disorders, blood glucose regulation with rapid insulin drip, administration of thyroid hormone activity antagonists and management of pneumonia with adequate antibiotics. Discussion: DKA and thyroid crisis are two separate events and their co-occurrence is rare. Both are life-threatening conditions that if not treated promptly will lead to death. The pathophysiology of the coincidence of DKA and thyroid crisis is unknown and debated. One theory states that thyrotoxicosis will change carbohydrate metabolism and increase insulin resistance by increasing glycogen breakdown in the liver, while uncontrolled glucose production will increase metabolic damage. Management of this coincidence requires tight regulation of the patient's glucose levels as the administration of corticosteroids in the management of thyroid crisis runs the risk of increasing glucose levels and thus aggravating the patient's DKA condition. Conclusion: A case of DKA coincidence with thyroid crisis triggered by pneumonia in a 57-year-old woman at RSUD Klungkung has been reported. By correcting fluid and electrolyte balance disturbances, tight blood glucose regulation, administration of antithyroid and corticosteroids at optimal doses and handling pneumonia with adequate antibiotics gave good results to the patient.
Co-Authors Adisastra, Suryantha Ari Sepriyanti, Ni Komang Purwa Sunu, Arya Baruna Putri Purnama Dewi, Ni Made Putu Ekaruna, Ida Bagus