Thyroid storm associated with testicular choriocarcinoma

Abstract

Thyroid storm is a rare, life-threatening condition that can be caused by various pathologies including serious conditions associated with human chorionic gonadotropin (hCG)-producing tumours. We present the case of a 17-year-old male patient with a 1-month history of dyspnoea and a 3-day history of palpitations and fever. General examination revealed a left testicular mass. Blood tests revealed β-hCG >225,000 mIU/ml, thyroid-stimulating hormone (TSH) 0.02 IU/ml, and thyroxine (T4) 19.07 μg/dl. He was admitted with thyroid storm. Treatment with antithyroid drugs and chemotherapy was started, but the patient died on the third day of admission. This case highlights a rare occurrence of thyroid storm linked to testicular choriocarcinoma, and provides a necessary reminder that, in some instances, hCG at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of TSH. Learning Points • Thyroid storm is rarely associated with testicular choriocarcinoma. • Sometimes, human chorionic gonadotropin at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of thyroid-stimulating hormone. • The clinical course and management of thyroid storm secondary to testicular choriocarcinoma in a young male is described.