{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:10:16Z","timestamp":1756321816854,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,2]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8\u2009weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU\/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6\u2009days later with features of thyrotoxicosis. TVUS demonstrated a 198\u00d7110\u00d7165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU\/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the \u2018hook effect\u2019. Following appropriate dilution, the hCG was reported as 4 573 344 mIU\/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3\u2009days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre.<\/jats:p>","DOI":"10.1136\/bcr-2024-259812","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T10:45:12Z","timestamp":1727779512000},"page":"e259812","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Rare complications of complete hydatidiform molar pregnancy: the \u2018hook effect\u2019 and thyrotoxicosis"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1436-5433","authenticated-orcid":false,"given":"Amy","family":"Shearer","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srdjan","family":"Saso","sequence":"additional","affiliation":[{"name":"Imperial College London Department of Surgery and Cancer, London, UK"},{"name":"West London Gynaecological Cancer Center, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catriona","family":"Stalder","sequence":"additional","affiliation":[{"name":"West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-0443","authenticated-orcid":false,"given":"Benjamin","family":"Jones","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive & Developmental Biology, Imperial College London Faculty of Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"key":"2025082711283554000_17.10.e259812.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.073"},{"key":"2025082711283554000_17.10.e259812.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60280-2"},{"key":"2025082711283554000_17.10.e259812.3","doi-asserted-by":"crossref","first-page":"3461","DOI":"10.31557\/APJCP.2021.22.11.3461","article-title":"Can Pretreatment Serum Beta-hCG be Used for Predicting Thyrotoxicosis in Gestational Trophoblastic Disease?","volume":"22","author":"Khomphaiboonkij","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025082711283554000_17.10.e259812.4","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000002848","article-title":"Factors Associated With Mortality of Thyroid Storm","volume":"95","author":"Ono","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"2025082711283554000_17.10.e259812.5","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2010.143479"},{"key":"2025082711283554000_17.10.e259812.6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/ijgo.13877","article-title":"Diagnosis and management of gestational trophoblastic disease: 2021 update","volume":"155 Suppl 1","author":"Ngan","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"key":"2025082711283554000_17.10.e259812.7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.gynor.2011.10.003","article-title":"Abnormally low hCG in a complete hydatidiform molar pregnancy: The hook effect","volume":"1","author":"Nodler","year":"2011","journal-title":"Gynecol Oncol Case Rep"},{"key":"2025082711283554000_17.10.e259812.8","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1056\/NEJM198903093201005","article-title":"Specificity Spillover at the Hormone Receptor \u2014 Exploring Its Role in Human Disease","volume":"320","author":"Epstein","year":"1989","journal-title":"N Engl J Med"},{"key":"2025082711283554000_17.10.e259812.9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.78.4.862"},{"key":"2025082711283554000_17.10.e259812.10","doi-asserted-by":"crossref","DOI":"10.1186\/s13044-021-00092-3","article-title":"Hyperthyroidism in gestational trophoblastic disease - 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