Multisystem challenges in reproductive medicine: A case report of bicornuate uterus, fibroadenoma, and postpartum thyroiditis

RATIONALE: A bicornuate uterus is an uncommon mullerian duct malformation strongly associated with recurrent early pregnancy loss and adverse obstetric outcomes. When combined with endocrine disturbances such as hyperprolactinemia and postpartum thyroid dysfunction, fertility becomes even more challenging. This case highlights how coordinated reproductive-endocrine management can overcome multiple intersecting barriers to conception and successful pregnancy. PATIENT CONCERNS: A 24-year-old woman presented with a history of 3 first-trimester miscarriages, difficulty conceiving, and prior breast fibroadenoma excision. Following the birth of her first child, she later developed symptoms of palpitations, weight loss, and anxiety suggestive of thyroid dysfunction. DIAGNOSES: Pelvic ultrasonography identified a bicornuate uterus. Additional evaluation revealed isolated hyperprolactinemia, a benign right breast fibroadenoma, and postpartum-onset hyperthyroidism occurring several months after initiating depot medroxyprogesterone acetate (DMPA) contraception. INTERVENTIONS: Management included empirical hormonal and metabolic support with progesterone, metformin, low-molecular-weight heparin, and low-dose aspirin, together with thyroid hormone therapy. She was followed jointly by obstetrics and endocrinology throughout conception, pregnancy, and the postpartum period. OUTCOMES: The patient achieved a viable term pregnancy and delivered a healthy infant via cesarean section at 38 weeks. Postpartum thyrotoxicosis was confirmed biochemically and successfully managed with antithyroid medication. LESSONS: This case demonstrates that favorable reproductive outcomes are achievable even in the presence of significant uterine malformation and endocrine comorbidities when care is individualized and multidisciplinary. The temporal relationship between DMPA initiation and postpartum thyroiditis raises a clinically relevant question about progestin-triggered autoimmune thyroid dysfunction, warranting further study. Early imaging and endocrine profiling should be routine in women presenting with recurrent pregnancy loss.