These associations were found to be independent by multiple regression analysis. Patient age, sex, palpable or fixed lymph nodes, radiation exposure, and race did not differ between the patient group with and those without vascular invasion. Preliminary analysis of our data suggests that the presence of vascular invasion in papillary, thyroid carcinoma, even within the thyroid gland, is associated with more aggressive disease at diagnosis and with a higher incidence of tumor recurrence.

Objective: Gestational trophoblastic disease and hyperreactio luteinalis (HL) are rare, but important, etiologies of hyperandrogenism that need to be further studied.Methods: We present a case of rapidly progressing hirsutism and marked biochemical androgen excess in the context of pregnancy.Results: A 26-year-old woman with a past medical history of obesity, prediabetes, and polycystic ovary syndrome presented with worsening hirsutism and markedly elevated testosterone levels. She was subsequently found to be pregnant, with extremely elevated levels of serum β-human chorionic gonadotropin. Subsequent workup led to the identification of molar pregnancy and bilaterally enlarged ovaries, suggestive of HL. Following surgical intervention and therapy with methotrexate for invasive mole, she experienced improvement in both biochemical and clinical androgen excess features.Conclusion: With the prevalence of polycystic ovary syndrome, many women present to medical providers with hirsutism or other findings of hyperandrogenism. However, rapid progression of existing hirsutism or severe hirsutism should prompt more extensive evaluations to rule out rare etiologies. One such etiology found in pregnancy is HL, in which high levels of β-human chorionic gonadotropin can stimulate production of benign theca lutein cysts, leading to marked hyperandrogenism and virilizing symptoms. (AACE Clinical Case Rep. 2019;5:e86-e90) Abbreviations: 17-OHP = 17-hydroxyprogesterone; β-hCG = β-human chorionic gonadotropin; DHEA-S = dehydroepiandrosterone-sulfate; GTD = gestational trophoblastic disease; HL = hyperreactio luteinalis; MRI = magnetic resonance imaging; PCOS = polycystic ovary syndrome; SHBG = sex hormone-binding globulin; TSH = thyroid-stimulating hormone

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