Acute Pulmonary Edema as a Manifestation of Thyroid Crisis From Hydatidiform Mole: A Case Report.

Objective: To report a clinical case of complete hydatidiform mole (CHM) with significant impact on thyroid function, associated with the development of acute pulmonary edema in the period following uterine evacuation.

Case report: A 46-year-old woman sought medical attention due to significant vaginal bleeding, with marked elevation of serum β-hCG (greater than 300,000 mIU/mL), as well as transvaginal ultrasonography with imaging suggestive of HM. After uterine evacuation, the patient developed acute respiratory failure with dyspnea and chest pain, requiring intensive care admission and mechanical ventilation. Thyroid storm was diagnosed based on clinical presentation, laboratory findings, and Burch-Wartofsky criteria (50 points). Additional investigations excluded pulmonary embolism and primary thyroid disease. Removal of the HM resulted in decreased β-hCG titers; however, normalization of serum thyroid hormone levels occurred only after pharmacological treatment.

Conclusion: This case highlights the potential progression of hCG-mediated thyrotoxicosis to thyroid crisis after uterine evacuation and emphasizes the importance of early recognition and treatment of severe hyperthyroidism in patients with HM. Early diagnosis and prompt management may help prevent thyroid crisis and cardiopulmonary complications. This case also demonstrates that acute pulmonary edema and transient cardiac dysfunction may occur as severe manifestations of thyroid crisis associated with gestational trophoblastic disease (GTD). Furthermore, close collaboration among obstetric, endocrine, and critical care teams is essential to optimize outcomes in complex presentations.