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Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model
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Thyroid Storm Caused by Hyperemesis Gravidarum.

Chelsea F Zimmerman1, Alexandra B Ilstad-Minnihan2, Brittany S Bruggeman1

  • 1Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida.

AACE Clinical Case Reports
|May 23, 2022
PubMed
Summary

Thyroid storm in pregnancy, though rare, can occur due to elevated human chorionic gonadotropin (hCG) from hyperemesis gravidarum. This case highlights a severe instance that resolved with treatment as hCG levels decreased.

Keywords:
AKI, acute kidney injuryGTT, gestational transient thyrotoxicosisHG, hyperemesis gravidarumIV, intravenousPTU, propylthiouracilSSKI, saturated solution potassium iodideTSH, thyroid-stimulating hormonehCGhyperemesis gravidarumpregnancythyroid storm

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Area of Science:

  • Endocrinology
  • Obstetrics & Gynecology
  • Reproductive Medicine

Background:

  • Hyperemesis gravidarum (HG) is associated with elevated human chorionic gonadotropin (hCG), which can cause transient thyrotoxicosis.
  • Thyroid storm during pregnancy is uncommon and typically linked to autoimmune hyperthyroidism.

Observation:

  • A 16-week pregnant patient presented with hyperthyroidism, vomiting, and organ dysfunction, diagnosed as thyroid storm.
  • Elevated hCG levels (246,030 mIU/L) and suppressed TSH with high free thyroxine (>6.99 ng/dL) were noted.
  • The patient received methimazole, potassium iodide, and propranolol, with rapid improvement and medication discontinuation.

Findings:

  • The patient's thyroid storm was attributed to hCG elevation secondary to HG, not autoimmune thyroid disease.
  • Thyroid autoantibodies were absent, thyroid ultrasound was normal, and thyroid function normalized as hCG levels declined.
  • Medications were tapered and discontinued within 10 days, with sustained normal thyroid function post-discharge.

Implications:

  • hCG can stimulate the TSH receptor, leading to thyroxine overproduction, especially when hCG levels peak.
  • This case underscores the importance of evaluating hCG levels in pregnant patients with thyroid storm symptoms.
  • Timely diagnosis and management are crucial for favorable prognosis and follow-up in HG-associated thyroid storm.