Abstract
Gestational trophoblastic diseases, which include molar pregnancy, have an increased risk of complications associated with the thyroid gland. This condition is mainly caused by elevated levels of beta-human chorionic gonadotropin produced during pregnancy, which is exaggerated in molar pregnancy and can lead to thyrotoxicosis. Hence, it is important to recognize the signs and symptoms of hyperthyroidism among women of childbearing age to prevent complications such as thyroid storm. Medical management of thyroid storm before surgery is critical to prevent adverse maternal outcomes. Here, we report a rare case of impending thyroid storm induced by molar pregnancy.
Highlights
Pregnancy is associated with physiological changes in both maternal thyroid gland volume and function because of an interplay among beta-human chorionic gonadotropin (β-hCG), estrogen, and the thyroid gland
This condition is mainly caused by elevated levels of beta-human chorionic gonadotropin produced during pregnancy, which is exaggerated in molar pregnancy and can lead to thyrotoxicosis
CT of the abdomen and pelvis was consistent with the ultrasound findings of enlarged uterus measuring 21.7 cm × 14.6 cm × 11.4 cm, with enhancing nodular and hypodense areas concerning for molar pregnancy
Summary
Pregnancy is associated with physiological changes in both maternal thyroid gland volume and function because of an interplay among beta-human chorionic gonadotropin (β-hCG), estrogen, and the thyroid gland. A 48-year-old female (gravida 6, para 3023) with a history of pre-eclampsia in a previous pregnancy was referred to the emergency room by her gynecologist at 11 weeks of gestation due to symptoms of headache, nausea, vomiting, vaginal spotting, and elevated blood pressure (BP) concerning for pre-eclampsia. As the calculated Burch-Wartofsky score of 30 was concerning for impending thyroid storm, she was admitted to the intensive care unit for further management She was started on intravenous labetalol infusion and magnesium sulfate for blood pressure control and seizure prophylaxis, respectively. Pathological evaluation of the mass demonstrated an absence of fetal parts with positive p57 staining supporting the diagnosis of a complete hydatidiform mole She was discharged on methimazole 20 mg twice daily and nifedipine 90 mg daily. She was advised contraception with a plan to initiate methotrexate therapy for chemoprophylaxis
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