The pre-eclampsia like syndrome is a rare, severe complication during pregnancy weeks 16- 24 at multipara, elder women known or not to suffer of subclinical/overt hypothyroidism. It is characterized by persistent hypertension, under hypotensive therapy, progressive abdominal ascites, and bilateral pleural/pericardial effusions, severe proteinuria aggravated from day–to–day. The pathological mechanisms are partially different from those of gestational hypertension, being a diastolic disorder, with changes in plasma volume, and a very early endothelial dysfunction generating vasoconstriction in kidneys’ vessels and systemic circulation, and systemic inflammatory response. The plasma volume changes are initiating the volume-dependent mechanism of reduced plasma renine activity on one side, and on the other the increase of proteinuria to high values like those from the ephritic syndrome, with the increase of the excretion of thyroxine and thyroid-binding globulins, which sometimes can not be compensated, and aggravates the hypothyroidism High TSH levels are correlated to endothelin high levels. The diagnosis is a challenge to distinguish pre-eclampsia like syndrome from other forms of gestational hypertension. High doses levothyroxine are mandatory, and may help maternal life salvage, not the fetus, mothers having high risk for future cardiovascular events.
 

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