Severe Thyrotoxicosis Caused by Molar Pregnancy: A Case Report and Review of the Literature.

Severe thyrotoxicosis is an acute and life-threatening state of hyperthyroidism. While it is a rare presentation of hyperthyroidism, it is clinically significant because of its high mortality and necessitates early identification and treatment to reduce the incidence of poor outcomes. The most common causes of this hypermetabolic state are Graves' disease, toxic thyroid adenoma or multinodular goiter, thyroiditis, iodine-induced hyperthyroidism, and excessive intake of levothyroxine. The less common causes include trauma, medications (i.e., amiodarone), discontinuation of anti-thyroid medications, and interactions with sympathomimetic medications such as ketamine that may be administered during general anesthesia. Regardless of etiology, thyrotoxicosis management should be coordinated using an interdisciplinary team-based approach to optimize outcomes. We discuss a molar pregnancy requiring emergency surgery as an uncommon cause of thyrotoxicosis and highlight appropriate management steps. The patient's symptoms resolved post-operatively, and her post-operative laboratory results (thyroid function and beta-human chorionic gonadotropin {ß-hCG}) were followed until they normalized. The patient's preoperative presentation and preparation with a multidisciplinary team discussion, intraoperative anesthetic considerations and course, and post-operative management and follow-up are described.

A mystery client study of crisis pregnancy center practices in New York State.

OBJECTIVES: To evaluate practices of crisis pregnancy centers (CPCs) in a state with supportive abortion policies. STUDY DESIGN: We called all New York State CPCs regarding their services using a "mystery client" protocol, utilizing checklists and thematic analysis. RESULTS: Of 86 CPCs, 67 (78%) encouraged in-person appointments, offering free medical services and support. Twelve centers (14%) spontaneously disclosed their non-medical status, and 36 (42%) disclosed after direct questioning. Sixty-five (76%) made inaccurate or inflammatory statements about pregnancy or abortion. CONCLUSIONS: In a state without specific barriers to abortion and pregnancy care, CPCs claim to provide support while using inflammatory rhetoric and concealing their organizational status.