An unusual cause of cardiothyreosis

Abstract

Severe hyperthyroidism can cause cardiac complications, such as severe rhythm disturbances, heart failure and angina. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from benign hydatidiform mole to malignant form. Clinical hyperthyroidism may occur in GTD, as human chorionic gonadotropin (hCG) secreted by molar tissue is structurally similar to thyroid-stimulating hormone. Cardiothyreosis in this context is exceptional. We report the case of a nulligravida 42-year-old woman without thyroid or cardiac history who presented to the emergency department for dyspnoea. Examinations revealed an acute pulmonary oedema and sinus tachycardia. Serum hCG concentration was abnormally high (762 878 UI/l, N < 5). CT scan showed a voluminous uterine mass and eliminated pulmonary embolism. Cardiac output was increased in echocardiography. Complementary blood tests showed a peripheral hyperthyroidism. GTD was evoked in the context of uterine mass and high hCG concentration, which was responsible for inducing clinical hyperthyroidism and cardiothyreosis. A total hysterectomy was performed and histopathological examinations concluded to a non-invasive complete hydatidiform mole (begnin form). hCG fell to normal within 12 weeks, cardiac and thyroid functions normalized after mole evacuation.

Application of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) to patients with endometriosis

“…Additionally, cyclic pelvic pain is a dominant symptom of endometriosis that may worsen with time and is known to interfere with a woman's health from a holistic point of view [ 9 11 12 ]. In addition to clinical symptoms, women with endometriosis experience several non-clinical symptoms including depression, emotional disturbances, sexual difficulties, difficulty with social commitments, and lack of energy [ 13 ].…”

“…QOL is defined by the World Health Organization (WHO) as “An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” [ 14 ]. Endometriosis affects a woman's QOL by influencing physical functioning and daily activities, interfering with intimate relationships, causing diagnostic delay, as well as affecting mental health and work productivity [ 10 13 ].…”