1
|
Da Silva Santos T, Santos Monteiro S, Pereira MT, Garrido S, Leal M, Andrade C, Vilaverde J, Dores J. Severe Hyperthyroidism and Complete Hydatidiform Mole in Perimenopausal Woman: Case Report and Literature Review. Cureus 2022; 14:e22240. [PMID: 35340459 PMCID: PMC8929662 DOI: 10.7759/cureus.22240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/12/2022] Open
Abstract
Gestational trophoblastic disease (GTD) represents a heterogeneous group of disorders within placental trophoblastic cells that are rather rare in perimenopausal ages. One of its complications is the development of secondary clinical hyperthyroidism, which can be potentially complicated if not properly and early recognized. We report the case of a 50-year-old perimenopausal woman, gravida 2 para 2, who presented to the emergency department with severe acute lower abdominal pain and abnormal uterine bleeding for one month. She also reported abnormal sweating and palpitation for a one-week duration and amenorrhea for the previous three months. Abdominal examination showed a pelvic mass resembling a 15-week sized uterus. Serum β-hCG levels were strongly increased, and abdomen ultrasound displayed an enlarged uterus with “snow-storm” features, compatible with the diagnosis of GTD. Laboratory data revealed suppressed TSH levels and high free thyroxine and free triiodothyronine levels (4 and 1.5 times above the upper limit of normality, respectively). Thyrotropin-receptor antibodies (TRAb) levels were negative, and thyroid ultrasound excluded major structural disease. She was managed with anti-thyroid drugs, Lugol’s iodine, beta-blockers, and steroids during preoperative care. Thereafter, she underwent surgery, being diagnosed with a hydatidiform mole postoperatively. Her thyroid function returned to normal after three months, without the further need for antithyroid drugs. This case highlights the importance of considering GTD as an aetiology for thyrotoxicosis in perimenopausal women, especially in the absence of findings suggesting primary thyroid disease.
Collapse
|
2
|
Hodgson JA, Pittman BP, Solomon JB, Elrefai A, Kristobak BM. Postoperative Thyroid Storm After Evacuation of a Complete Hydatidiform Mole: A Case Report. A A Pract 2021; 15:e01495. [PMID: 34170868 DOI: 10.1213/xaa.0000000000001495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gestational trophoblastic disease can lead to excess thyroid hormone release and rarely, thyroid storm. We present a case of complete molar pregnancy with hyperthyroidism that was not identified or treated before surgical evacuation of uterine contents. Untreated hyperthyroidism preoperatively led to unanticipated thyroid storm immediately after emergence from anesthesia. It is important for anesthesia providers to recognize the link between gestational trophoblastic disease and thyrotoxicosis, and appreciate the severe consequences than can occur if left untreated. Anesthesia providers should strongly consider preoperative consultation and treatment. Being prepared to treat intraoperative symptoms and thyroid storm is paramount.
Collapse
Affiliation(s)
- John A Hodgson
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia.,the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Benjamin P Pittman
- the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James B Solomon
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia.,the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ahmed Elrefai
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia
| | - Benjamin M Kristobak
- the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| |
Collapse
|
3
|
Pereira JVB, Lim T. Hyperthyroidism in gestational trophoblastic disease - a literature review. Thyroid Res 2021; 14:1. [PMID: 33446242 PMCID: PMC7807451 DOI: 10.1186/s13044-021-00092-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Gestational trophoblastic disease (GTD) is a group of pregnancy-related disorders that arise from abnormal proliferation of placental trophoblast. Some patients with GTD develop hyperthyroidism, a rare but potentially life-threatening complication requiring early detection and management. Existing literature on hyperthyroidism in GTD is scant. This review aims to analyse the epidemiology, pathophysiology and management of this phenomenon. METHODS A comprehensive search of MEDLINE, EMBASE and Cochrane Library was performed to obtain articles that explored hyperthyroidism in GTD. A total of 405 articles were screened and 228 articles were considered for full-text review. We selected articles that explored epidemiology, pathophysiology and outcomes/management of hyperthyroidism in GTD. RESULTS The pathophysiology of hyperthyroidism in GTD is well-investigated. Placental trophoblastic tissue secretes excessive hCG, which is structurally similar to thyroid stimulating hormone and also has enhanced thyrotropic activity compared to normal hCG. The incidence and prevalence of hyperthyroidism in GTD varies worldwide, with lower rates associated with high uptake of early antenatal screening and early GTD detection. No clear risk factors for hyperthyroidism in GTD were identified. While hyperthyroidism can be definitively managed with surgical evacuation of the uterus, severe complications associated with hyperthyroidism in GTD have been reported, including thyroid storm-induced multi-organ failure, ARDS, and pulmonary hypertension. CONCLUSION Early detection of GTD is critical to prevent development of hyperthyroidism and its associated complications. Hyperthyroidism should be recognised as an important perioperative consideration for women undergoing surgery for GTD, and requires appropriate management. Future studies should explore risk factors for hyperthyroidism in GTD, which may facilitate earlier identification of high-risk women.
Collapse
Affiliation(s)
- Jarett Vanz-Brian Pereira
- Faculty of Medicine, University of New South Wales, Wallace Wurth Building - UNSW Sydney, 18 High St, Kensington NSW, Sydney, 2052, Australia.
| | - Taylor Lim
- Faculty of Medicine, University of New South Wales, Wallace Wurth Building - UNSW Sydney, 18 High St, Kensington NSW, Sydney, 2052, Australia
| |
Collapse
|
4
|
Lamine F, Camponovo C, Baud D, Werner D, Marino L, Sykiotis GP. Relapse of Human Chorionic Gonadotropin-Induced Hyperthyroidism and Severe Hyperemesis Gravidarum Secondary to Twin-Twin Transfusion Syndrome, With Rapid Recovery Following Fetoscopic Laser Coagulation: Case Report. Front Endocrinol (Lausanne) 2021; 12:705567. [PMID: 34335476 PMCID: PMC8322681 DOI: 10.3389/fendo.2021.705567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Limited data have shown that, compared to uncomplicated twin pregnancies, pregnancies complicated by twin-twin transfusion syndrome (TTTS), a life-threatening condition, are associated with higher maternal serum levels of both human chorionic gonadotropin (hCG) and thyroid hormones. With the continuing expansion of assisted reproductive technologies, the rate of twin pregnancies, including those complicated by TTTS and associated hyperemesis gravidarum, is expected to increase further. Therefore, detailed descriptions of the maternal and fetal clinical outcomes of maternal thyrotoxicosis linked to TTTS can be useful for timely diagnosis and management. However, such descriptions are currently lacking in the literature. CASE PRESENTATION We report the case of a 30-year-old woman carrying a monochorionic twin pregnancy complicated by TTTS that induced a relapse of severe hyperemesis gravidarum with overt non-autoimmune hyperthyroidism at 17 weeks of gestation. Following fetoscopic laser coagulation (FLC), both hyperemesis and hyperthyroidism improved within 1 week. CONCLUSIONS The present experience contributes to the knowledge base on maternal thyrotoxicosis linked to TTTS and can be useful in the diagnosis and treatment of future cases; it also emphasizes the need for a high degree of clinical suspicion and for close collaboration between endocrinologists and obstetricians. Another key point is that TTTS-associated hyperemesis gravidarum and maternal hyperthyroidism should be considered in the differential diagnosis of refractory or relapsing hyperemesis gravidarum in women with monochorionic twin pregnancy, because this condition may require more stringent supportive treatment before and during the FLC procedure when the mother is overtly hyperthyroid.
Collapse
Affiliation(s)
- Faiza Lamine
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Camponovo
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Baud
- Obstetric Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dominique Werner
- Laboratory of Clinical Chemistry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laura Marino
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerasimos P. Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Gerasimos P. Sykiotis,
| |
Collapse
|
5
|
Blick C, Schreyer KE. Gestational Trophoblastic Disease-induced Thyroid Storm. Clin Pract Cases Emerg Med 2019; 3:409-412. [PMID: 31763601 PMCID: PMC6861026 DOI: 10.5811/cpcem.2019.9.43656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/16/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022] Open
Abstract
In the United States, gestational trophoblastic diseases (GTD), including molar pregnancies, occur in 121 out of 100,000 pregnancies.1 Many patients with GTD may develop hyperthyroidism. GTD-induced thyroid storm is a rare but life-threatening complication of GTD.2 Once patients are hemodynamically stable, the mainstay of definitive treatment is evacuation of the mole.3 We present a case of molar pregnancy-induced thyroid storm presenting as vaginal bleeding, fever, and tachycardia.
Collapse
Affiliation(s)
- Carly Blick
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Kraftin E Schreyer
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
Filipescu GA, Solomon OA, Clim N, Milulescu A, Boiangiu AG, Mitran M. Molar pregnancy and thyroid storm - literature review. ARS MEDICA TOMITANA 2017. [DOI: 10.1515/arsm-2017-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Molar pregnancies results from a tainted fertilization process. Trophoblastic thyroidian hyper function is an unusual complication of a molar pregnancy. The degree of thyroid stimulation and the severity of clinical hyperthyroidism is directly proportional to HCG concentration. Human chorionic gonadotrophin is almost identical with TSH, luteinizing hormone (LH) and follicle-stimulating hormone, this analogy in the structure will cause cross-reactivity with their receptors. Hyperthyroid status can vary from asymptomatic hyper function to thyroid storm. Dilation and curettage represents the treatment for hyperthyroidism in molar pregnancy. Awareness of this condition is important for diagnosis and treatment.
Collapse
Affiliation(s)
- G. A. Filipescu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Oana Alina Solomon
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Nicoleta Clim
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Amelia Milulescu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | | | - M. Mitran
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, “Panait Sirbu” Hospital, Bucharest , Romania
| |
Collapse
|
7
|
|
8
|
Wie JH, Kwon JY, Ko HS, Lee Y, Shin JC, Park IY. Thyroid storm and early-onset proteinuric hypertension caused by a partial molar pregnancy. J OBSTET GYNAECOL 2017; 36:351-2. [PMID: 26977975 DOI: 10.3109/01443615.2015.1065229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J H Wie
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - J Y Kwon
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - H S Ko
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - Y Lee
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - J C Shin
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - I Y Park
- a Department of Obstetrics and Gynecology , College of Medicine, The Catholic University of Korea , Seoul , Korea
| |
Collapse
|
9
|
Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne) 2017; 8:163. [PMID: 28775711 PMCID: PMC5517413 DOI: 10.3389/fendo.2017.00163] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
The hypothalamus-pituitary-thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.
Collapse
Affiliation(s)
- Apostolos Chatzitomaris
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- *Correspondence: Apostolos Chatzitomaris,
| | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| | | | - Steffen Hering
- Department for Internal Medicine, Cardiology, Endocrinology, Diabetes and Medical Intensive Care Medicine, Krankenhaus Bietigheim-Vaihingen, Bietigheim-Bissingen, Germany
| | - Aline Urban
- Department for Anesthesiology, Intensive Care and Palliative Medicine, Eastern Allgäu-Kaufbeuren Hospitals, Kaufbeuren, Germany
| | | | - Assjana Abood
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Harald H. Klein
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| |
Collapse
|
10
|
Samra T, Kaur R, Sharma N, Chaudhary L. Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy. Indian J Anaesth 2016; 59:739-42. [PMID: 26755840 PMCID: PMC4697247 DOI: 10.4103/0019-5049.170035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.
Collapse
Affiliation(s)
- Tanvir Samra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranvinder Kaur
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Neha Sharma
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Lalita Chaudhary
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| |
Collapse
|
11
|
Kofinas JD, Kruczek A, Sample J, Eglinton GS. Thyroid Storm-induced Multi-organ Failure in the Setting of Gestational Trophoblastic Disease. J Emerg Med 2015; 48:35-8. [DOI: 10.1016/j.jemermed.2014.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 07/11/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
|
12
|
Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne) 2014; 5:102. [PMID: 25071718 PMCID: PMC4076793 DOI: 10.3389/fendo.2014.00102] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/15/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency. DATA SOURCE We searched the electronic MEDLINE database on September 2013. Data Selection and Data Extraction: Reviews, original articles, and case reports on "myxedematous coma," "HC," "thyroid storm," "TS," "massive goiter," "huge goiter," "prevalence," "etiology," "diagnosis," "therapy," and "prognosis" were selected. DATA SYNTHESIS AND CONCLUSION Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques - e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.
Collapse
Affiliation(s)
- Giampaolo Papi
- Department of Endocrinology, Catholic University of Rome, Rome, Italy
| | | | - Alfredo Pontecorvi
- Department of Endocrinology, Catholic University of Rome, Rome, Italy
- *Correspondence: Alfredo Pontecorvi, Department of Endocrinology, Catholic University of Rome, Largo A. Gemelli 1, 00168 Rome, Italy e-mail:
| |
Collapse
|
13
|
Boufettal H, Mahdoui S, Noun M, Hermas S, Samouh N. [Hyperthyroidism in molar pregnancy]. Rev Med Interne 2013; 35:202-5. [PMID: 24074966 DOI: 10.1016/j.revmed.2013.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 02/11/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hyperthyroidism is a rare complication of molar pregnancy. CASE REPORT We report a 39-year-old woman who presented a thyrotoxic syndrome accompanying a molar pregnancy. Serum thyroid hormones were elevated and returned to normal level after uterine evacuation of a molar pregnancy. The authors detail the role of thyroid stimulating property of human gonadotropin chorionic hormone and its structural changes during the gestational trophoblastic diseases. These changes give the latter the thyroid stimulating properties and signs of hyperthyroidism. CONCLUSION Molar pregnancy may be a cause of hyperthyroidism. The diagnosis of molar pregnancy should be a mention to thyrotoxicosique syndrome in a woman of childbearing age.
Collapse
Affiliation(s)
- H Boufettal
- Service de gynécologie-obstétrique « C », faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc.
| | - S Mahdoui
- Service de gynécologie-obstétrique « C », faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - M Noun
- Service de gynécologie-obstétrique « C », faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - S Hermas
- Service de gynécologie-obstétrique « C », faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - N Samouh
- Service de gynécologie-obstétrique « C », faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| |
Collapse
|
14
|
Barrera JR, Sandoval MAS, Quiwa LQ, Paz-Pacheco E. The interplay of Graves' disease and twin molar pregnancy. BMJ Case Rep 2013; 2013:bcr-2013-008604. [PMID: 23436894 DOI: 10.1136/bcr-2013-008604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Twin molar pregnancy with coexistent viable fetus in a patient with Graves' disease is a rare entity. The patient is a 37-year-old woman who was hospitalised owing to persistent vomiting and vaginal bleeding. The pregnancy test was positive and the pelvic ultrasound disclosed twin gestation of complete mole and a coexistent viable 12-week fetus. β-Human chorionic gonadotropin (β-HCG) and free thyroid hormones were both elevated. The patient was also a diagnosed case of Graves' disease prior to this pregnancy. Given the risks for perinatal complications, the patient was offered early termination of pregnancy. She, however, decided to continue her pregnancy and control the hyperthyroidism with an antithyroid drug (ATD). A week after her discharge from the hospital, she had spontaneous abortion and the histopathology of the abortus revealed complete hydatidiform mole and a 13-week fetus.
Collapse
Affiliation(s)
- Jerome Rebollos Barrera
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines, Phillippine General Hospital, Manila, Philippines.
| | | | | | | |
Collapse
|
15
|
Dietrich JW, Landgrafe G, Fotiadou EH. TSH and Thyrotropic Agonists: Key Actors in Thyroid Homeostasis. J Thyroid Res 2012; 2012:351864. [PMID: 23365787 PMCID: PMC3544290 DOI: 10.1155/2012/351864] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 11/21/2012] [Indexed: 12/11/2022] Open
Abstract
This paper provides the reader with an overview of our current knowledge of hypothalamic-pituitary-thyroid feedback from a cybernetic standpoint. Over the past decades we have gained a plethora of information from biochemical, clinical, and epidemiological investigation, especially on the role of TSH and other thyrotropic agonists as critical components of this complex relationship. Integrating these data into a systems perspective delivers new insights into static and dynamic behaviour of thyroid homeostasis. Explicit usage of this information with mathematical methods promises to deliver a better understanding of thyrotropic feedback control and new options for personalised diagnosis of thyroid dysfunction and targeted therapy, also by permitting a new perspective on the conundrum of the TSH reference range.
Collapse
Affiliation(s)
- Johannes W. Dietrich
- Lab XU44, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum (UK RUB), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, NRW, Germany
| | - Gabi Landgrafe
- Lab XU44, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum (UK RUB), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, NRW, Germany
- Klinik für Allgemein- und Visceralchirurgie, Agaplesion Bethesda Krankenhaus Wuppertal gGmbH, Hainstraße 35, 42109 Wuppertal, NRW, Germany
| | - Elisavet H. Fotiadou
- Lab XU44, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum (UK RUB), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, NRW, Germany
| |
Collapse
|
16
|
Schilddrüse und Schwangerschaft. GYNAKOLOGISCHE ENDOKRINOLOGIE 2012. [DOI: 10.1007/s10304-012-0487-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
17
|
Goldman AM, Mestman JH. Transient non-autoimmune hyperthyroidism of early pregnancy. J Thyroid Res 2011; 2011:142413. [PMID: 21785688 PMCID: PMC3139186 DOI: 10.4061/2011/142413] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 12/22/2022] Open
Abstract
It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyroid autoimmunity that resolves spontaneously by 16 weeks gestation without significant obstetrical complications.
Collapse
Affiliation(s)
- Alexander M Goldman
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | | |
Collapse
|
18
|
Banet N, Lininger RA, Willis MS, McCudden CR. Self-Discovered Breast Mass in a 38-Year-Old Woman. Lab Med 2011. [DOI: 10.1309/lmc8k2vq3boqpxtg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
19
|
Current world literature. Curr Opin Obstet Gynecol 2010; 21:541-9. [PMID: 20072097 DOI: 10.1097/gco.0b013e3283339a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
|
21
|
Adali E, Yildizhan R, Kolusari A, Kurdoglu M, Turan N. The use of plasmapheresis for rapid hormonal control in severe hyperthyroidism caused by a partial molar pregnancy. Arch Gynecol Obstet 2008; 279:569-71. [DOI: 10.1007/s00404-008-0762-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
|