Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Abstract

Thyrotoxicosis defined as a clinical manifestation of excess circulating thyroid hormone. Epidemiologic investigation reports 0.2% of thyrotoxicosis is caused by hydatidiform mole. The New England Trophoblastic Disease Centre (NETDC) mentioned that 20% of hydatidiform mole cases have thyrotoxicosis as one of its complications. The basic pathogenesis of thyrotoxicosis is the similarity of the HCG subunit to TSH which results in excessive stimulation of thyroid hormone. We present thethyrotoxicosis case in a 15-weeks pregnant woman with complete hydatidiform mole. The patient admitted to the hospital with blackish-red coloured bleeding and several hyperthyroidism complaints, laboratory test showed elevated levels of HCG and thyroid hormone and decreased TSH. Imaging studies done with ultrasound showed with snowflake pattern. The patient then treated with thyroid hormone suppressant therapy before the hydatidiform mole evacuation. Normalization of thyroid hormone levels should be made immediately before the mole evacuation to avoid lifethreatening thyroid storm complications. Tirotoksikosis merupakan manifestasi klinis akibat kelebihan hormon tiroid yang beredar dalam darah. Hasil epidemiologi mencatat sekitar 0,2% kasus tirotoksikosis dapat disebabkan oleh mola hidatidosa. The New England Thropoblastic Disease Centre (NETDC) menyebutkan 20% kasus mola hidatidosa di benua Asia memiliki komplikasi tirotoksikosis. Patofisiologi dasar tirotoksikosis adalah kemiripan subunit HCG dengan TSH yang mengakibatkan stimulasi produksi hormon tiroid yang berlebihan. Pada kesempatan ini dilaporkan sebuah kasus tirotoksikosis pada seorang wanita hamil usia 15 minggu dengan mola hidatidosa komplit. Pasien mengeluh perdarahan banyak berwarna merah kehitaman, disertai beberapa keluhan hipertiroidisme, hasil laboratorium menunjukkan peningkatan kadar HCG dan hormon tiroid, penurunan TSH disertai gambaran snowflake pattern pada hasil USG. Pasien kemudian diberikan terapi penekan hormon tiroid sebelum dilakukan evakuasi mola. Penekanan kadar hormon tiroid harus dilakukan segera sebelum tindakan evakuasi mola agar komplikasi badai tiroid yang dapat mengancam keadaan pasien dapat dicegah.

Atypical presentation of hyperthyroidism complicated complete hydatidiform mole in a 24-year-old female: a case report

“…In around half of the patients with CM, β- HCG levels are excessively high, reaching higher than 100 000 mIU/l. Extremely high β- HCG levels, generally greater than 500 000 mIU/l 4 , 16 . For trophoblastic disorders, the glycoprotein hormone β-HCG is a particular tumour marker.…”

Kehamilan Mola Hidatidosa Disertai Hipertiroid

“…Telah dibuktikan bahwa homologi dalam molekul hCG dan TSH, serta dalam reseptornya, yang bertanggung jawab atas reaktivitas silang hCG dengan reseptor TSH. [10] Glinoer memperkirakan bahwa ''untuk setiap 10.000 IU/L peningkatan serum hCG, FT4 meningkat sebesar 0,1 ng/dL, dan TSH berkurang sebesar 0,1 mIU/mL". Varian molekuler hCG yang ditemukan pada kehamilan mola telah meningkatkan potensi tirotropik.…”

“…Selain itu, beta blocker seperti propranolol atau atenolol dapat digunakan untuk mengendalikan gejala adrenergik, terutama pada tahap awal sambil menunggu obat antitiroid dalam perbaikan gejala. [10] Beberapa hal yang harus diperhatikan sebagai tindakan screening penyakit ini antara lain, perdarahan uterus pada awal pertama kehamilan, hilangnya denyut jantung janin dan struktus tubuh fetus, rahim mebesar dengan cepat, kadar β-hCG lebih tinggi dari usia kehamilan seharusnya, terdapat vesikel-vesikel, adanya kista teka lutein. [19] Kelemahan pada laporan kasus…”

Parents’ knowledge of graves’ disease as an autoimmune disease among children

“…This is called the phenomenon of thyrotoxicosis, which is a clinical manifestation of too much thyroid hormone. Symptoms that appear can include enlargement of the thyroid gland/goiter, heart rhythm disturbances, fever, weight loss, and bone loss (Nugraha & Samodro, 2019). If this happens without further treatment, the quality of life of an affected person can decrease, until at worst it leads to death.…”

“…Several studies have been conducted regarding Graves' disease in children. These studies have explored the incidence of graves' disease in children, effective treatment, complications of graves; disease, as well as the risk and etiologic factors of Graves' disease (Nugraha & Samodro, 2019;Srikandi, 2020;Subekti & Pramono, 2018;Yati et al, 2017). However, research related to parental perception of this disease has not been carried out.…”