[Perioperative management of cesarean section in a patient pregnant with twins complicated by hyperthyroidism].

A 30-year-old twin pregnant woman complicated with hyperthyroidism was scheduled to receive anesthesia for cesarean section. During the early months of pregnancy, her thyroid status was stimulated, being positive for TSH-binding inhibitor immunoglobulins (TBII). Because maternal positiveness of TBII correlates with neonatal hyperthyroidism, she was treated with antithyroid drugs (methimazole). Her thyroid status was suppressed gradually and her TBII level became negative. On the 38th week of pregnancy, she underwent cesarean section by lumbar spinal anesthesia and twin girls were delivered with Apgar scores of 9. The thyroid statuses of the twins were measured, showing that their thyroid functions to be almost equal, although they were dizygotic twins. T3 and free-T3 were below the normal limits for adults, but they did not require any therapy. Maternal level of TBII is considered to be a useful index for management of patients with hyperthyroidism during the perianesthetic period for cesarean section. In this type of patients the thyroid status of both the mother and fetus should be carefully followed.