Severe hyperthyroidism associated with hydatidiform mole

Transient Thyrotoxicosis in Molar Pregnancy

Molar pregnancy is one of the components of a broader spectrum of diseases known as Gestational Trophoblastic Disease (GTD), presenting with amenorrhoea and irregular bleeding which may be rarely associated with passage of vesicles per vagina. However, it can rarely be associated with hyperthyroidism, which may be associated with clinical features of hyperthyroidism. The following is a report of a 20-year-old woman who presented with amenorrhea followed by irregular bleeding per vagina, thyromegaly and abnormal levels of thyroid hormones. Transvaginal ultrasound revealed features consistent with molar pregnancy. A suction evacuation was done following which serum levels of β-hCG reduced and the levels of thyroid hormones also reduced. On follow up, six weeks later, β-hCG and thyroid hormones were within normal limits. The case and relevant literature are presented here.

Anesthetic management of a patient with hyperthyroidism due to hydatidiform mole

Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. Tachycardiac atrial fibrillation was detected by electrocardiography at the preoperative examination. No abnormalities were found in blood count, coagulation, biochemical tests, chest radiographs, or respiratory function. General anesthesia with nitrous oxide, oxygen, and sevoflurane, combined with fentanyl and 1% mepivacaine, was administered intermittently from an epidural catheter. Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward.

Total intravenous anesthesia for evacuation of a hydatidiform mole and termination of pregnancy in a patient with thyrotoxicosis

Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.