Thyrotoxicosis in the Setting of Hydatidiform Mole with Subsequent Development of Takotsubo Cardiomyopathy Complicated by COVID-19

Kara E Hensley; Christopher W Fiechter; Alysson Klein; Rhabia Hussein; Henry J Weiss; Mihail Zilbermint

doi:10.55729/2000-9666.1177

Thyrotoxicosis in the Setting of Hydatidiform Mole with Subsequent Development of Takotsubo Cardiomyopathy Complicated by COVID-19

J Community Hosp Intern Med Perspect. 2023 May 8;13(3):83-87. doi: 10.55729/2000-9666.1177. eCollection 2023.

Authors

Kara E Hensley^#^{1

2}, Christopher W Fiechter^#^{1

2}, Alysson Klein², Rhabia Hussein², Henry J Weiss², Mihail Zilbermint^{3

4

5}

Affiliations

¹ Lake Erie College of Osteopathic Medicine, Department of Medicine, Bradenton, FL, USA.
² Manatee Memorial Hospital, Graduate Medical Education, Bradenton, FL, USA.
³ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Hospital Medicine, Johns Hopkins Community Physicians, John Hopkins Medicine, Baltimore, MD, USA.
⁵ Department of Medicine, Suburban Hospital, Johns Hopkins Medicine, Bethesda, MD, USA.

^# Contributed equally.

Abstract

We present a rare case of hydatidiform molar pregnancy, which led to the development of thyroid storm, followed by a rare complication of takotsubo cardiomyopathy in the setting of a COVID-19 infection. A 21-year-old female of 22 weeks gestational age presented with heavy vaginal blood loss, brown emesis, tachycardia, and lethargy. Through clinical presentation and ultrasound confirmation, a molar pregnancy was diagnosed. Laboratory data and clinical presentation of thyrotoxicosis supported a diagnosis of thyroid storm. Test for COVID-19 was positive. The patient was treated with dilation and curettage, antithyroid medication, and blood transfusions, resulting in symptom resolution. Thereafter, echocardiography confirmed takotsubo cardiomyopathy. It is suspected that the homology in structure between the human chorionic gonadotropin (hCG) and thyroid stimulating hormone subunits resulted in thyroid storm secondary to receptor cross-reactivity. We speculate that subsequent cardiovascular stress of b-hCG-induced thyroid storm with superimposed COVID-19 infection facilitated the development of Takotsubo cardiomyopathy.

Keywords: Beta-hCG; COVID-19; Gestational trophoblastic disease; Hyperthyroidism; Molar pregnancy; Stress induced cardiomyopathy; Thyrotoxicosis.

Publication types

Case Reports