Thyroid Storm Caused by Hyperemesis Gravidarum

Chelsea F. Zimmerman, MD; Alexandra B. Ilstad-Minnihan, BA; Brittany S. Bruggeman, MD; Bradley J. Bruggeman, MD; Kristin J. Dayton, MD; Nancy Joseph, MBBS; Daniel I. Moas, MD; Henry J. Rohrs, MD

AACE Clinical Case Reports (May 2022)

Thyroid Storm Caused by Hyperemesis Gravidarum

Chelsea F. Zimmerman, MD,
Alexandra B. Ilstad-Minnihan, BA,
Brittany S. Bruggeman, MD,
Bradley J. Bruggeman, MD,
Kristin J. Dayton, MD,
Nancy Joseph, MBBS,
Daniel I. Moas, MD,
Henry J. Rohrs, MD

Affiliations

Chelsea F. Zimmerman, MD: Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida; Address correspondence to Dr Chelsea Zimmerman, Endocrinology and Metabolism of East Alabama, 2420 Village Professional Parkway, Opelika, AL 36801.
Alexandra B. Ilstad-Minnihan, BA: College of Medicine, University of Florida, Gainesville, Florida
Brittany S. Bruggeman, MD: Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida
Bradley J. Bruggeman, MD: Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, Florida
Kristin J. Dayton, MD: Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida
Nancy Joseph, MBBS: Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
Daniel I. Moas, MD: Division of Pediatric Critical Care, College of Medicine, University of Florida, Gainesville, Florida
Henry J. Rohrs, MD: Division of Pediatric Endocrinology, College of Medicine, University of Florida, Gainesville, Florida

Journal volume & issue: Vol. 8, no. 3
pp. 124 – 127

Abstract

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Background: Transient thyrotoxicosis has been documented in the setting of hyperemesis gravidarum (HG) with elevated human chorionic gonadotropin (hCG) levels. Thyroid storm in pregnancy is rarer and typically associated with autoimmune hyperthyroidism. We described thyroid storm in a primigravid 18-year-old patient due to hCG level elevation secondary to HG, which resolved in the second trimester of pregnancy. Case Report: Our patient presented with vomiting, hyperthyroidism, and cardiac and renal dysfunction at 16 weeks’ gestation. She was clinically found to have a thyroid storm, with undetectable thyroid-stimulating hormone (TSH) and a free thyroxine level of >6.99 ng/dL. The hCG level was elevated at 246 030 mIU/L (9040-56 451 mIU/L). She was treated with methimazole, saturated solution potassium iodide, and propranolol. Because thyroid autoantibodies were absent, thyroid ultrasound yielded normal results, and thyroid function testing results rapidly improved as the hCG level decreased, the medications were tapered and ultimately discontinued by day 10 of hospitalization. The thyroid function remained normal after discharge. Discussion: Because hCG and TSH have identical alfa subunits and similar beta subunits, hCG can bind to the TSH receptor and stimulate thyroxine production. The hCG level peaks at around 8-14 weeks of gestation, correlating with decreased TSH levels in this same time frame. This case emphasizes the relevant physiology and importance of timely and thorough evaluation to determine the appropriate management, prognosis, and follow-up for patients with thyroid storm in the setting of HG. Conclusion: Although transient thyrotoxicosis is documented in patients with HG, thyroid storm is rare, and our case illustrates a severe example of these comorbidities.

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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