When Pregnancy Turns Toxic: Thyrotoxic Crisis and Psychosis as the First Clues of Gestational Trophoblastic Disease.

Abstract

A molar pregnancy is more than just an obstetric issue—it can act like an endocrine time bomb. Although most women affected may only show mild or biochemical signs of thyrotoxicosis, there is always a serious risk that it could quietly escalate into a dangerous, life-threatening thyroid storm. This case report presents a clear example involving a 28-year-old Saudi woman, G2P1, who was brought to our facility with unusual behavior, auditory hallucinations, severe anxiety, agitation, and abnormal uterine bleeding—occurring after two months of amenorrhea, initially mistaken for menstrual irregularity. Her beta-hCG level exceeded 100,000, and ultrasound findings were consistent with a molar pregnancy. Following successful stabilization over 24 to 36 hours, she underwent an uncomplicated suction dilation and curettage (D&C) as definitive treatment. Subsequently, she was placed under long-term follow-up with both endocrinology and gynecologic oncology teams.