Paraneoplastic hyperthyroidism

Köhler, Stefanie; Tschopp, Oliver; Jacky, E; Schmid, Christoph

doi:10.1136/bcr.04.2011.4163

Cited by 6 publications

(1 citation statement)

References 8 publications

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“…HCG and TSH-beta subunit are highly homologous (3): both contain 12 half-cysteine residues and one N-linked oligosaccharide, and three disulphide bonds from a cysteine knot structure are identical in both hormones and essential for binding to the receptor (4). HCG is, therefore, able to cross-react with the TSH receptor (5) and can induce hyperthyroidism when the HCG levels are high enough (3).…”

Section: Discussionmentioning

confidence: 99%

Choriocarcinoma Presenting with Thyrotoxicosis

Sotello

Rivas

Test

et al. 2016

Baylor University Medical Center Proceedings

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We describe a 26-year-old man with metastatic choriocarcinoma who presented with hyperthyroidism associated with elevated β-human chorionic gonadotropin (B-HCG) and respiratory failure secondary to diffuse lung metastasis. After the first cycle of chemotherapy, the concentration of B-HCG dramatically decreased and the patient became euthyroid, allowing us to discontinue antithyroid medications. The patient's hyperthyroidism was caused by stimulation of the thyroid gland by high B-HCG levels, as shown by the marked improvement of the patient's thyroid function panel after chemotherapy.H uman chorionic gonadotropin (HCG)-induced hyperthyroidism is a rare cause of hyperthyroidism. It is seen in patients suff ering from conditions associated with extremely high levels of HCG, such as hyperemesis gravidarum, hydatidiform moles, and germ cell tumors. At very high levels, HCG can stimulate the TSH receptor, causing hyperthyroidism (1). We present the case of a 26-year-old man diagnosed with metastatic choriocarcinoma and concomitant hyperthyroidism related to extremely high levels of β-human chorionic gonadotropin (B-HCG). Th e patient's hyperthyroidism resolved as the B-HCG decreased because of chemotherapy. CASE DESCRIPTIONA previously healthy 26-year-old man presented with a 3-week history of fever, chills, cough, hemoptysis, and dyspnea. He also reported anxiety, palpitations, hand tremors, and a 30-pound weight loss in a 3-month period. A chest radiograph showed multiple diff use nodules of 1 to 3.5 cm throughout both lung fi elds (Figure 1). Upon presentation at our hospital, his heart rate was 136 beats per minute, and his respiratory rate was 25 breaths per minute. On initial exam he had fi ne crackles in both lung bases. Th e thyroid gland and scrotal examinations were unremarkable. His free thyroxine was 4.14 ng/dL (normal, 0.93-1.7); free triiodothyronine, 10.6 pg/mL (normal, 2.3-4.2); thyroid-stimulating hormone (TSH), <0.01 mcIU/mL (normal, 0.27-4.20); B-HCG, 616,433 MIU/mL (normal, 1-5); lactate dehydrogenase, 1232 IU/L (normal, 135-225); alanine aminotransferase, 53 IU/L (normal, 7-40); and aspartate aminotransferase, 61 IU/L (normal, 10-42). Th e patient was started on methimazole, dexamethasone, and propranolol. Testicular ultrasound showed a heterogeneous right testicle with microlithiasis and a 10 mm septated upper pole cyst, with moderate right hydrocele. Computed tomography (CT) of the head, chest (Figure 2), abdomen, and pelvis suggested diff use metastasis of the brain, lungs, liver, and retroperitoneal lymph nodes. CT-guided biopsy of one of the lung nodules was consistent with metastatic choriocarcinoma based on positive staining for B-HCG.Th e patient was treated with bleomycin, etoposide, and cisplatin. After completing his fi rst chemotherapy cycle, his serum B-HCG decreased signifi cantly and the thyroid function panel improved to near normalization (Table 1). Methimazole was decreased from 45 mg to 10 mg daily and was discontinued 3 weeks after he completed the fi rst cycle of chemotherapy...

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Section: Discussionmentioning

confidence: 99%

Choriocarcinoma Presenting with Thyrotoxicosis

Sotello

Rivas

Test

et al. 2016

Baylor University Medical Center Proceedings

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Testicular Choriocarcinoma: a Rare Variant that Requires a Unique Treatment Approach

Reilley

Pagliaro

2015

Curr Oncol Rep

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Testicular germ cell tumors represent the most common malignancy among young men. While 5-year overall survival and cure for this population is greater than 95%, choriocarcinoma is an aggressive subtype of this disease with far worse prognosis--5-year survival for choriocarcinoma is less than 80%. In order to be able to treat these patients appropriately, a provider must recognize characteristic features of choriocarcinoma including elevated human chorionic gonadotropin in a young man with testicular mass; the astute clinician should also know the signs and symptoms of choriocarcinoma syndrome, characterized by bleeding from metastatic sites, which represents a medical emergency and is associated with high morbidity and mortality. Treatment should be directed towards a goal of tumor marker normalization, and patients with refractory disease should be considered for advanced therapies and clinical trials. Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival.

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Paraneoplastic Hyperthyroidism in Advanced Testicular Non-Seminomatous Germ Cell Tumors: Prevalence and Clinical Management

Angerer,

Hansen,

Wülfing

et al. 2024

Oncology

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Introduction Paraneoplastic hyperthyroidism (PH) has been reported in patients with testicular germ cell tumors (GCTs), sporadically. This disorder is caused by extremely elevated serum levels of beta-human chorionic gonadotropin (bHCG). To date, little is known about the prevalence of PH, and its clinical features are poorly understood. The aim of the present study was to analyze the relative frequency and clinical features of PH in GCTs and evaluate their effects on therapeutic outcomes. Methods A cohort of 438 patients treated for testicular GCT from to 2017-2023 was retrospectively analyzed for histology, age, clinical stage, and presence of PH. The clinical features of the patients with PH were evaluated descriptively. The relative frequency of PH was compared among the subgroups using descriptive statistical methods. Results Three patients with PH were identified; all had clinical symptoms of hyperthyroidism, suppressed serum levels of thyroid-stimulating hormone (TSH), and increased levels of triiodothyronin (fT3). All the patients had advanced, metastasized, and non-seminomatous (GCTs). Serum bHCG levels ranged from 225,00 U/l to 1,520,000 U/l. The prevalence of PH was 0.7% in the entire GCT population and 60% in those with very high bHCG serum levels. All the patients received standard cisplatin-based chemotherapy along with thyrostatic treatment. The clinical symptoms of the hyperthyroidism rapidly disappeared. Thyroid-stimulating hormone (TSH) levels normalized with decreasing bHCG levels. The PH treatment did not affect the therapeutic outcomes of the patients. Conclusion PH may occur in 0,7% of all patients with GCT, but may be present in up to 60% of patients with very high levels of bHCG. Measuring serum levels of TSH and fT3 should be performed in addition to routine diagnostic measures in all patients with poor prognosis GCTs. Thyrostatic medication is recommended for patients with the clinical symptoms of hyperthyroidism. Early recognition of hyperthyroidism and prompt intervention will reduce comorbidity and help optimize therapeutic outcomes.

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Paraneoplastic hyperthyroidism

Cited by 6 publications

References 8 publications

Choriocarcinoma Presenting with Thyrotoxicosis

Choriocarcinoma Presenting with Thyrotoxicosis

Testicular Choriocarcinoma: a Rare Variant that Requires a Unique Treatment Approach

Paraneoplastic Hyperthyroidism in Advanced Testicular Non-Seminomatous Germ Cell Tumors: Prevalence and Clinical Management

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