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Thực hành xử lý sản khoa - Trường hợp 4

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 4', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 51 An 18-ycar-old Ỉ2 PI at 35 weeks gestation has a history of Graves disease and is under treatment with oral propylthiouracil. She states that over the last day she has been feeling as though her heart is pounding. She also complains of nervousness sweating and diarrhea. On examination her BP is 150 110 HR 140 bpm RR 25 min and temperature 100.8 E The patient appears anxious disoriented and somewhat confused. The thyroid gland is mildly tender and enlarged. The cardiac examination reveals tachycardia with a III VI systolic murmur. The fetal heart rate tracing shows a baseline in the 160 bpm range without decelerations. Deep tendon reflexes are 4 with clonus. Her leukocyte count is 20 000 mm What is the most likely diagnosis What is the best management for this condition 3 9 2 CASE 111 I S OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 51 Thyroid Storm in Pregnancy Siimmarv All 18-ycar-old G2 Pl at 35 weeks gestation is taking PTU For Graves disease. She has a I-day history of palpitations nervousness sweating and diarrhea. On examination her BP is 150 110 HR 140 bpm RR 25 min and temperature 100.8 F. The patient appears anxious disoriented and somewhat confused. The thyroid is mildly tender and enlarged. Deep tendon reflexes are 4 with clonus. She has a leukocytosis. Most likely diagnosis Thyroid storm. Best management for this condition A beta blocker such as propranolol corticosteroids and PTU. Analysis Objectives 1. Know that the most common cause of hyperthyroidism in the United States is Graves disease. 2. Recognize the clinical presentation and danger of thyroid storm. Considerations This 18-year-old woman at 35 weeks gestation has a history of hyperthyroidism due to Graves disease. In the United States the majority of hyperthyroidism is due to Graves disease the clinical presentation is typically that of a painless uniformly enlarged thyroid gland with occasional proptosis. She is being treated with propylthiouracil PTU which is the most commonly used .