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Obstetrics and gynaecology
Rare complications of complete hydatidiform molar pregnancy: the ‘hook effect’ and thyrotoxicosis
  1. Amy Shearer1,
  2. Srdjan Saso2,3,
  3. Catriona Stalder4 and
  4. Benjamin Jones1,5
  1. 1Imperial College Healthcare NHS Trust, London, UK
  2. 2Imperial College London Department of Surgery and Cancer, London, UK
  3. 3West London Gynaecological Cancer Center, Imperial College Healthcare NHS Trust, London, UK
  4. 4West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
  5. 5Department of Metabolism, Digestion and Reproduction, Institute of Reproductive & Developmental Biology, Imperial College London Faculty of Medicine, London, UK
  1. Correspondence to Dr Amy Shearer; amy.shearer1{at}nhs.net

Abstract

A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8 weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6 days later with features of thyrotoxicosis. TVUS demonstrated a 198×110×165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the ‘hook effect’. Following appropriate dilution, the hCG was reported as 4 573 344 mIU/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3 days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre.

  • Obstetrics and gynaecology
  • Pregnancy
  • Thyrotoxicosis
  • Ultrasonography

https://doi.org/10.1136/bcr-2024-259812

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: AS wrote the article. BJ supervised the writing and edited the article. CS reviewed the patient and performed the ultrasound and provided the images. SS supervised and offered expert opinion. The following author gave final approval of the manuscript: BJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.