Endocrine Abstracts

JOINT297

A middle-aged female (gravida 6, para 5) presented at 12 weeks amenorrhoea to the emergency department for persistent nausea and vomiting in pregnancy. Previous pregnancies had been uneventful. She described palpitations, which led to the discovery of hyperthyroidism in pregnancy. A trans-vaginal ultrasound revealed a bulky uterus with complex echogenic endometrial mass containing multiple small cystic areas. Hyperthyroidism was attributed to markedly elevated β-HCG from gestational trophoblastic disease. She underwent urgent dilatation and curettage after medical optimization and under close peri-operative monitoring. Thyroid function normalized within a few short weeks. β-HCG levels showed good early response with sharp decline over the first 2 weeks. However, the figure then plateaued above 10000 IU/l, leading to suspicion of persistent disease and gestational trophoblastic neoplasia. Imaging with computed tomography showed multiple pulmonary nodules and she was commenced on chemotherapy thereafter.