Hyperemesis, hyperthyroidism, or both?

Nausea and vomiting are common during pregnancy and, when severe enough to require intervention, may develop into the syndrome known as hyperemesis gravidarum. When the diagnosis of hyperemesis is considered, a careful search for secondary causes is necessary. The list of secondary causes includes hyperthyroidism, a relatively uncommon condition during pregnancy. Because many of the signs and symptoms of hyperthyroidism are common, and thyroid function tests are more difficult to interpret during normal pregnancy, making the diagnosis of hyperemesis gravidarum is a challenge. The decision to treat or to await spontaneous resolution depends on the severity of the illness and the likelihood of the presence of true Graves' disease. The case summarized here demonstrates these issues, and includes treatment options for hyperemesis-associated hyperthyroidism.