Trophoblastic Hyperthyroidism and Its Perioperative Concerns

Kurdi, Madhuri S

doi:10.5772/57523

Cited by 3 publications

(9 citation statements)

References 64 publications

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“…Normal HCG level in Pregnant Women. 3 In a molar pregnancy, elevated HCG levels occur not only in the early trimester, but also continue to rise to the level above 100.000 mIU/ml. The HCG increase then will stimulate the thyroid gland through the TSH receptor to produce and release T3 and T4 excessively.…”

Section: Discussionmentioning

confidence: 99%

“…When the thyroid hormone is released in the bloodstream, these hormones still harm thyroid releasing hormone (TRH) and TSH, this explains why thyrotoxicosis patients in hydatidiform mole will show very low TSH levels. 3,10 Delaying evacuation of hydatidiform mole because of controlling thyrotoxicosis could increase the perioperative morbidity and complication, but ignoring to control thyrotoxicosis before evacuation procedure can develop a thyroid storm too. So we have to do aggressive medical management to control thyroid levels first, following with removal of molar tissue for the successful outcome in the patient and prevent morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Excess hormone in circulation will stimulate increased activity from receptor organs, thus causing more organ dysfunction. 3 Propylthiouracil (PTU), carbimazole, and methimazole or thiamazole are the drug of choice for inhibiting the function of thyroid peroxidase (TPO), as well as decreasing oxidation and iodide influx so that the production of thyroid hormone can be inhibited. Methimazole or thiamazole have to administer 20-40 mg/day and may be used as a single daily dose if the patient has reached or approached euthyroid state.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The new England trophoblastic disease center (NETDC) estimates that 20% of hydatidiform mole cases in Asia have thyrotoxicosis complications, but only 5% of all cases have clear clinical signs. 3 Some research was trying to reveal the magnitude of the cases in Indonesia. One research in determining the prevalence of thyrotoxicosis cases in hydatidiform mole has been done in Prof. dr. R. D. Kandou Manado central goverment hospital from 1 January to 31 December 2014.…”

Section: Introductionmentioning

confidence: 99%

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Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Nugraha

Samodro²

2019

JKKI

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Nugraha

Samodro²

2019

JKKI

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“…Other studies showed that the prevalence of thyrotoxicosis in GTN patients was around 50%, and it was potentiallyable to cause death. The development of an early detection test 3,4 led to the decrease of the mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia with Hyperthyroidism

Rahmadhona

Tambunan

2020

Indonesian J. Clin. Pathol. Med. Lab.

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Introduction. Gestationaltrophoblastic neoplasia(GTN) is a malignant lesion arising from placental villous and extra-villous trophoblast, occuring in 1:40,000 pregnancies. Invasive mole and choriocarcinoma are the vast majority of GTN, produce substantial amounts of human chorionic gonadotropin (hCG). Hyperthyroidism in GTN is due to stimulation of thyroid gland by hCG which has a similar structure with thyroid stimulating hormone (TSH).Case. A 28-year-old female, suspected with choriocarcinoma and anemia, had history of recurrent vaginal bleeding in 8 months, accompanied with loss of appetite, weight loss, palpitation and tremor. Physical examination: pulse rate 114x/minutes, respiration rate 26x/minutes, temperature 38 0C, conjunctival anemia and dyspneu. Laboratory: anemia, leukocytosis, hypoalbuminemia, hypokalemia, increase ofLDH, increase of bhCG >1,500,000 mIU/mL, T4 14.1 ug/dL (4.40-10.90 ug/dL), FT4 1.95 ng/dL (0.89-1.76 ng/dL), and decrease of TSH. Abdominal CT Scan suggested uterine mass suspected as malignancy infiltrating to rectum with metastatic features in liver, base of left lung, spleen and left kidney. Increased CA-125, and metastatic features of lung right paracardial and left suprahilar from Chest X-ray were found.Discussion.GTN diagnostic criteria include: increased bhCG examined ³4 x; increased bhCG ³3 weekly examination; histology diagnosis of choriocarcinoma; increased bhCG > 20,000 more than 4 weeks post evacuation and the presence of metastasis. Hyperthyroidism in GTN is potentially life threatening because of heart failure and thyroid storm.Conclusion.Hyperthyroidism increases morbidity and mortality in GTN patient, so periodic thyroid examination is essential to prevent further complication of hyperthyroidism.

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Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

Febrianto

Novida

2022

CIMRJ

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Patients with thyroid dysfunction are well represented in the general population. Hyperthyroidism can develop as a paraneoplastic syndrome in germ cell tumors. Testicular seminoma as a form of germ cell tumors, can express human chorionic gonadotropin (hCG). Beta-hCG strongly resembles TSH. A 26-year-old male with a history of cryptorchidism, came to Dr. Soetomo Hospital with the complaints of palpitation, diarrhea, weight loss, fatigue, nervousness, excessive sweating, and heat intolerance. He also complained of enlarged breast and a palpable mass in lower abdomen for 4 months. From the TSH and FT4 examinations, patient’s symptoms were in accordance with thyrotoxicosis. Anti-TPO and thyroid USG examination were within normal limits. Patient was treated with beta-blocker and thiamazole. Histopathology of abdominal mass showed a testicular seminoma. After surgery and chemoterapy, the clinical symptoms of hyperthyroidism gradually improved. Administration of beta-blocker and thiamazole was stopped in 4 months after surgery. Many of germ cell tumors in male are associated with cryptorchidism, half of them being testicular seminoma. Seminoma expresses hCG. At very high levels, hCG can stimulate the TSH receptors, causing hyperthyroidism or thyrotoxicosis. TSH and FT4 measurement were needed in patient with suspected hyperthyroidism. Anti-TPO test is performed to exclude autoimmune cause of thyroid disease. Symptomatic management of beta-hCG induced hyperthyroidism is not different from hyperthyroidism in general, namely administration of beta-blocker and anti-thyroid drugs. However, the definitive treatments are surgery and chemotherapy. Hyperthyroidism in germ cell tumors almost all responds well to surgery and chemotherapy.Patients with thyroid dysfunction are well represented in the general population. Hyperthyroidismcandevelopasaparaneoplasticsyndromeingermcelltumors.Testicularseminomaasaformofgermcelltumors,canexpresshumanchorionicgonadotropin(hCG). Beta-hCGstronglyresemblesTSH.A26-year-oldmalewithahistoryofcryptorchidism,cametoDr.SoetomoHospitalwiththecomplaintsofpalpitation,diarrhea,weightloss, fatigue, nervousness, excessive sweating, and heat intolerance. He also complained ofenlargedbreastandapalpablemassinlowerabdomenfor4months.FromtheTSHandFT4examinations,patient’ssymptomswereinaccordancewiththyrotoxicosis.Anti-TPOandthyroidUSGexaminationwerewithinnormallimits.Patientwastreatedwithbeta-blocker andthiamazole.Histopathology ofabdominal massshowedatesticularseminoma.After surgery andchemoterapy,theclinicalsymptomsofhyperthyroidismgraduallyimproved. Administration ofbeta-blockerand thiamazolewasstoppedin 4monthsaftersurgery.Many ofgermcelltumorsin maleareassociatedwith cryptorchidism,halfofthembeing testicular seminoma.SeminomaexpresseshCG. At veryhighlevels,hCGcanstimulatetheTSH receptors, causing hyperthyroidism or thyrotoxicosis. TSH and FT4 measurement were neededin patientwithsuspectedhyperthyroidism.Anti-TPOtestisperformedtoexclude autoimmunecauseof thyroiddisease. Symptomaticmanagementof beta-hCGinduced hyperthyroidismisnotdifferentfromhyperthyroidismingeneral,namely administrationof beta-blocker and anti-thyroid drugs. However, the definitive treatments are surgeryand chemotherapy.Hyperthyroidismingermcell tumorsalmostall respondswelltosurgery and chemotherapy.

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Trophoblastic Hyperthyroidism and Its Perioperative Concerns

Cited by 3 publications

References 64 publications

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Gestational Trophoblastic Neoplasia with Hyperthyroidism

Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

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