Thyrotoxicosis and thyroid storm—a review of evaluation and management

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Molar pregnancy is a not-uncommon diagnosis in our patient population, occurring in approximately 0.6 to 1.1 per 1000 pregnancies. As the age of childbearing increases, the additional risk increases as well, to 7.5-fold higher by age 40 years. Medical complications associated with molar pregnancies include pre-eclampsia, hypertension, electrolyte disturbances, anemia, and thyrotoxicosis. Serum β-human chorionic gonadotropin (β-hCG) levels of 50,000 mIU/mL are approximately equivalent to a thyroid-stimulating hormone level of 35 U/mL. Because of the cross-reactivity between BHCG and TSH and the high levels of BHCG produced in gestational trophoblastic disease, the rare complication of thyroid storm is one that we as obstetricians may be called to manage. The diagnosis of thyroid storm may carry a 1.8 to nearly 20% mortality rate in hospitalized patients and thus requires prompt diagnosis and intervention. Once treatment is administered, including high-dose propylthiouracil, iodine solution, and dexamethasone with appropriate supportive care, patients can be expected to improve clinically within 24–48 hours. A case demonstrating the clinical picture of an obstetrics and gynecology patient with thyroid storm is presented, with a review of thyroid hormone activity and the management of thyroid storm.