Thyroid Storm in a Twin Pregnancy Presenting as Severe Hypertension and Preterm Labor

Background: Thyroid storm is a rare, life-threatening endocrine emergency in pregnancy with significant maternal and neonatal implications. Clinical symptoms may mimic those of hypertensive disorders in pregnancy. Prompt diagnosis and multidisciplinary management are critical for reducing maternal and neonatal morbidity and mortality. Case: A 31-year-old woman with a dichorionic diamniotic twin pregnancy, chronic hypertension, short cervix, and poorly controlled Graves' disease presented at 22 weeks' gestation with vaginal bleeding and severe-range blood pressures. She was diagnosed with thyroid storm and admitted to the intensive care unit. She failed to respond to maximal medical management, ultimately requiring plasmapheresis. She later developed preterm labor and spontaneously delivered periviable twins. She eventually underwent total thyroidectomy for definitive management of thyroid storm. Conclusion: This case illustrates the severe consequences of poorly controlled Graves' disease in pregnancy. Although thyroid storm can mimic preeclampsia, abnormal thyroid function tests, persistent tachycardia, fevers, and hypertension with wide pulse pressures may help distinguish it. Timely recognition and multidisciplinary care are imperative to decrease morbidity and mortality associated with thyroid storm.