Hyperthyroidism due to secretion of human chorionic gonadotropin in a patient with metastatic choriocarcinoma

Abstract

A 26-year-old pregnant woman presenting with repeated episodes of vaginal bleeding, weight loss, and shortness of breath was diagnosed with choriocarcinoma with metastases to both lungs. Chorionic gonadotropin levels (hCG) were >2.5 x 10 6 mU/mL. Consistent with hCGinduced subclinical hyperthyroidism, she had a suppressed TSH of 0.037mU/L (0.49 -4.67), a T4 of 18.1µg/dL (4.9 -10.7), and T3 of 136ng/dL (45 -137). Chemotherapy with a combined regimen with etoposide, methotrexate, and dactinomycine was started. The initial course was complicated by urosepsis with respiratory distress requiring endotracheal intubation for 3 days. She then improved rapidly, and her thyroid function tests were within normal limits by day 12. Six months later, after ten cycles of chemotherapy, the patient was in remission without signs of residual tumor or hCG-induced paraneoplastic activity.

Human Chorionic Gonadotropin-Induced Hyperthyroidism in Germ Cell Cancer – a Case Presentation and Review of the Literature

“…In the following years, several reports substantiated the observation of hyperthyroidism in patients with trophoblastic tumors [2][3][4][5][6]. Giralt et al [5] reported hyperthyroidism in 7 out of 17 male patients with germ cell cancer and hCG levels of higher than 50,000 IU/l.…”

“…Based on our clinical experience in treatment of testicular cancer and in light of the work reported by Madersbacher et al [7], it seems that in hCG-producing non-seminomatous germ cell tumors even excessively elevated hCG does not necessarily induce hyperthyroidism. While hyperthyroidism due to malignancy (trophoblastic tumors, hydatidiform moles, choriocarcinoma or testicular cancer) is a rare event, the prevalence of hCG-induced clinically manifest hyperthyroidism during pregnancy is about 0.05-0.2% in some series and up to 1% in others [6,8]. Even more so, according to Glinoer et al [8], close to 20% of pregnant women will have suppressed TSH, 2% will have suppressed TSH with increased thyroxin, and approximately 1% of pregnant women will have suppressed TSH, increased thyroxin and clinical signs of hyperthyroidism.…”

“…Yoshimura et al [17] suggested that one of the roles of the carboxyl-terminal peptide may be to prevent hyperthyroidism in the first trimester of pregnancy when a large amount of hCG is produced by the placenta. It is commonly accepted that excessive levels of hCG during the first trimester of pregnancy or in the rare event of hCGsecreting malignancy may result in hyperthyroidism due to crossreaction with the TSH receptor [6,9]. This results in a stimulation of the thyroid gland with excessive secretion of thyroid hormones which does not underlie the hypothalamicpituitary-thyroid hormone regulatory axis [2].…”

“…Standardized recommendations for the treatment of hCG-induced hyperthyroidism in patients with testicular cancer do not exist [2]. In the case of symptomatic hyperthyroidism, the use of beta receptor antagonists and/or thyreostatic drugs is suggested [6]. Since, in the case of underlying hCG-secreting malignant disease, the symptom of hyperthyroidism represents a paraneoplastic syndrome, the specific therapy consists of antineoplastic treatment [3,6].…”

Tinjau Ulang Nilai Faktor Penduga dan Rumus Diskriminan untuk Mendiagnosis Hipertiroid pada Mola Hidatidosa

“…14,15 Korelasi antara kadar HCG dan beratnya derajat metabolik hipertiroid adalah 25.000 U/L HCG setara dengan 1 mU/L aktivitas TSH. 16 Untuk membedakan mola hidatidosa dengan kehamilan normal dapat dengan melihat perbedaan kadar HCG total di dalam darah. Van Trommel dkk.…”