Thyroid Storm Caused by Hyperemesis Gravidarum

Abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Gestational Transient Thyrotoxicosis Complicated by Thyroid Storm in a Patient With Hyperemesis Gravidarum

“…Both conditions are usually transient and resolve spontaneously as hCG levels decline after reaching the peak at around 8 to 15 weeks of gestation [ 2 , 7 , 8 ]. Levels of hCG correlate with the degree of symptoms [ 3 , 6 , 7 ]. Patients with HG complicated by GTT may present with nausea, vomiting, weight loss, tachycardia, fine tremors, and mild proximal weakness at week 4 to 9 of gestation, although these clinical manifestations are not always evident and GTT may go unrecognized without an assessment of thyroid function [ 2 , 8 ].…”

“…The prevalence of GD during pregnancy ranges from 0.2% to 0.5% [ 5 , 8 ]. In contrast, GTT occurs in 2% to 11% of all pregnancies with a higher prevalence in Asian populations [ 2 , 3 , 5 , 7 , 8 ]. In both conditions, symptoms such as palpitations, anxiety, tremor, and heat intolerance are commonly found [ 1 ].…”

“…In summary, thyroid storm is a rare complication of hyperthyroidism and entails a high mortality rate of 10% to 30% if not recognized immediately and aggressively treated [ 10 ]. Although the incidence of thyroid storm in the setting of GTT is unknown, studies suggest that patients with hyperthyroidism during pregnancy are tenfold more likely to develop thyroid storm [ 3 , 10 ]. Our case illustrates how critical it is to determine the etiology of hyperthyroidism in early pregnancy, proper counseling on early identification of alarm symptoms, and it serves as an example of how GTT-associated thyroid storm may present.…”

“…Because of the short course and spontaneous resolution of GTT, the use of antithyroid drugs (ATD) is not routinely recommended [ 1-3 , 6-9 ]. The incidence of thyroid storm in the setting of GTT is unknown [ 3 ]. We describe a case of GTT complicated by thyroid storm in a primigravid 20-year-old patient with twin gestation and HG.…”

Editorial for May/June Issue of AACE Clinical Case Reports

“…3 In the field of Thyroid Disease, authors report case series of post COVID-19 vaccination induced thyroiditis 4 and recurrent subacute thyroiditis in a patient with human leukocyte antigen (HLA) associated predisposition to Graves disease 5 as well as a case of thyroid storm caused by hyperemesis gravidarum. 6 Another interesting case highlighted a rare metastatic location for isthmic papillary thyroid carcinoma presented as incidental solitary 4.7 cm adrenal incidentaloma. 7 Two additional cases under visual vignettes highlighted the differential diagnosis of thyroid/neck masses due to hyperplastic thyroid nodule within the remnant pyramidal lobe and branchial cleft remnant.…”