Overlapping Hyperemesis Gravidarum, Gestational Thyrotoxicosis, and Transaminitis in Early Pregnancy: A Case Report

Abstract

Hyperemesis Gravidarum (HG), characterized by excessive emesis, fluid depletion, electrolyte imbalance, and weight loss, is a condition that affects approximately 0.3-2% of pregnancies. In this case report, we highlight the importance of careful investigation, evaluation, and supportive management of a primigravida woman diagnosed with HG along with concurrent development of gestational transient thyrotoxicosis (GTT) and HG-associated transaminitis at ten weeks of gestation. HG typically starts in the first trimester, during which GTT is commonly observed. 

A 23-year-old primigravida in her first trimester of gestation presented with persistent vomiting, progressive fatigue, and an inability to maintain oral intake. Upon investigation, her liver enzymes were elevated, and thyroid function tests (TFTs) revealed a classic picture of transient hyperthyroidism, with negative thyroid receptor antibodies (TRAb)/thyroid-stimulating immunoglobulin (TSI).

Upon ruling out other causes, she was diagnosed with HG-associated transaminitis complicated by GTT. She was managed supportively with IV fluids, antiemetics, and thiamine. Due to the self-limiting nature of GTT, anti-thyroid drugs were not initiated. She was then discharged on Day 7 in a vitally stable condition. At the eight-week follow-up after discharge, symptoms and laboratory abnormalities improved. Recognizing the diagnostic complexity of overlapping HG, GTT, and HG-associated transaminitis is crucial for appropriate conservative management.