Gestational trophoblastic disease-induced thyroid storm: A case report

Gestational trophoblastic disease describes tumors caused by abnormal proliferation of trophoblastic tissue. A rare but potentially fatal complication is thyroid storm, which results from excessive thyroid hormone secretion stimulated by high levels of beta-human chorionic gonadotropin. A 28-year-old woman (gravida 4, para 1, with two prior miscarriages) presented with vaginal bleeding, abdominal pain, vomiting, palpitations, dyspnea, and an enlarging neck swelling. Examination revealed hypertension, tachycardia, hypoxia, an enlarged thyroid gland, pulmonary crackles, elevated jugular venous pressure, and a holosystolic murmur. The uterus was consistent with a 20-week gestation and was actively bleeding. The patient was confused and agitated without focal neurological deficits. Laboratory evaluation showed anemia, abnormal liver function, suppressed thyroid-stimulating hormone, and markedly elevated beta-human chorionic gonadotropin. Imaging demonstrated the classic "snowstorm" appearance of a molar pregnancy, which was confirmed by histopathology. The Burch-Wartofsky score supported the diagnosis of thyroid storm. She received anti-thyroid treatment and underwent uterine evacuation. Nine weeks after discharge, her hormone levels had normalized and serum beta-human chorionic gonadotropin was undetectable.