HighlightsOvert hypothyroidism needs to be treated with levothyroxine.Subclinical hypothyroidism treated with thyroxine has not been proven to improve maternal outcomes.Overt hyperthyroidism usually needs to be treated with thioamides.Subclinical hyperthyroidism does not require treatment.Evidence linking TPO antibodies with miscarriages and preterm labour is unequivocal.

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Figure 1. Viable intrauterine gestation and a solid mass in the right adnexa; suspected ectopic pregnancy. J Obstet Gynaecol Downloaded from informahealthcare.com by Chinese University of Hong Kong on 02/20/15 For personal use only.

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We present a rare case in an elderly Caucasian lady of primary ovarian carcinoid tumor, causing symptoms of the carcinoid syndrome and severe carcinoid heart disease. Carcinoid tumors are the commonest neuroendocrine tumors, the majority of which are found in the gastrointestinal tract and lungs. Ovarian carcinoids represent only 0.1% of all ovarian neoplasms and 1% of all carcinoid tumors. Carcinoid syndrome can present with flushing, diffuse watery diarrhea, wheezing and breathlessness and in advanced cases lead to carcinoid heart disease. This involves damage to the right heart structures and pulmonary hypertension, which can cause significant breathlessness and peripheral edema, and is associated with a worse prognosis. Diagnosis involves multi-modality radiological imaging and biochemical analysis of neuroendocrine tumor markers, and the first line treatment should always be resection of the tumor where possible. Prognosis is generally favorable, except in some cases with metastasis.

Sirenomelia or mermaid syndrome is a rare and fatal congenital condition, which is not associated with chromosomal anomalies. The fusion of the lower extremities characterizes it to form one single lower limb and its aetiology remains unclear. We report a rare case of 32-year-old woman who had a successful pregnancy following in-vitro-fertilization. A first trimester scan showed decreased liquor volume therefore she was referred to fetal medicine unit for a detailed scan at 22 weeks of gestation which showed bilateral thorax hypoplasia, bilateral renal agenesis and anhydramnios. The baby was delivered with the unexpected sirenomelia congenital anomaly and died four hours after birth.

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Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited condition with a prevalence of one in 40 000 individuals. It causes the development of tumours in endocrine glands, such as medullary thyroid cancer, pheochromocytomas, as well as primary hyperparathyroidism. MEN 2A in pregnancy is very rare with only 29 cases reported in the literature. The presence of pheochromocytoma is a rare cause of hypertension during pregnancy with an incidence of 0.007% of all pregnancies. This has severe implications on both mother and the foetus. This case report describes a 22-year-old nulliparous Caucasian woman with known MEN2A syndrome, who underwent thyroidectomy for medullary thyroid carcinoma in childhood and excision of left sided pheochromocytoma at the age of 19. She was found to have a recurrence of pheochromocytoma in the right adrenal gland during pregnancy at 16 weeks of gestation and was oddly normotensive. Catecholamine effects were blocked with phenoxybenzamine and she delivered by an uneventful elective caesarean section at 36 weeks gestation. She underwent a laparoscopic right adrenalectomy six weeks postpartum, followed by lifelong corticosteroid replacement.