Anaesthetic implications of severe hyperthyroidism secondary to molar pregnancy: A case report and review of literature

Swaminathan, Srinivasan; James, Roshin Ann; Chandran, Rashmi; Joshi, Reesha

doi:10.4103/aer.aer_38_17

Cited by 12 publications

(15 citation statements)

References 10 publications

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“…There are huge variations in the incidence of GTD in relation to ethnicity and geography, quoted as high as 1 in 400 pregnancies in Asia as opposed to 1 in 1500-2000 pregnancies in Europe and the United States. Following a molar pregnancy, risk of further GTD increases to 1% and w ith more such gestations risk increases by 15-20% [12,13].…”

Section: Discussionmentioning

confidence: 99%

Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

2020

JACCR

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Gestational Trophoblastic Disease (GTD) is a spectrum of tumours with abnormal placental trophoblastic proliferation. They can be benign or malignant lesions. When they invade locally or metastasise, they are called Gestational Trophoblastic Neoplasia (GTN). Clinically, women present with history of amenorrhoea, abdominal pain, mild to severe vaginal bleed with or without symptoms due to metastases. Based on the organ of metastasis, symptoms may vary from breathlessness and cough with chest involvement to lethargy, loss of memory or seizures with brain metastasis. This entity ranges from pre-malignant conditions like hydatidiform mole and partial hydatidiform mole to neoplastic invasive mole, choriocarcinoma or rare type of epitheloid trophoblastic tumour. [1,2] Undetected hyperthyroidism can complicate GTD and present with potential significant complications like cardiac failure and arrhythmias. Manifestations of the disease are attributed to excess secretion of human chorionic gonadotropin (HCG) that has thyrotrophic activity due to its structural similarity. [3,4] The incidence reported in Asian population is as high as 1:400, three times higher. In majority of cases, early diagnosis and treatment provide complete cure in GTD. In 20%, even locally invasive disease, with or without metastasis can be life threatening. [5] Surgical removal is the definitive treatment. Peri-operative anaesthetic management of patients with multiple system involvement as a result of extensive disease can be challenging, hence from anaesthetic perspective it is essential to understand the pathophysiology, clinical presentations and potential complications of molar pregnancy. We hereby report successful management of two cases presenting at different areas of the disease spectrum. Keywords: Molar pregnancy; Choriocarcinoma; Tropoblastic disease.

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Section: Discussionmentioning

confidence: 99%

Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

2020

JACCR

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“…Untreated thyroid crisis is known to be fatal in the perioperative period, particularly in the setting of emergency surgery [ [2] , [3] , 11 ]. Thus, it was decided that control of her hypermetabolic state and thyroid status prior to anesthetic administration and surgical intervention would minimize the risk of these complications, and result in a better long-term outcome than immediate surgical intervention [ 3 ]. If the patient had presented with a less advanced stage of GTD and was clinically stable, dilation and curettage would have been performed urgently and without preceding medical management.…”

Section: Discussionmentioning

confidence: 99%

“…The ultimate treatment for GTD is surgical evacuation of the proliferative trophoblastic tissue [ 2 ]. In cases of advanced GTD, patients must be evaluated for hyperthyroidism, and their hypermetabolic status and thyroid function must be optimized prior to surgery to prevent intraoperative complications [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Advanced gestational trophoblastic disease: A case report of medical management prior to surgical intervention

Lehto

Hitscherich

Argeros

2018

Case Reports in Women's Health

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BackgroundGestational trophoblastic disease (GTD) is a rare developmental form of proliferative trophoblastic tissue. Sparse literature exists regarding the optimal management of patients with advanced GTD, but the definitive treatment is urgent surgical intervention.CaseA 48-year-old woman presented advanced GTD. She was medically managed for hypertension and hyperthyroidism prior to surgical intervention in order to minimize the risk of anesthetic and surgical complications.ConclusionAdvanced GTD is rare. Undetected GTD can result in complications such as thyrotoxicosis, which poses substantial risks in the peri-operative period. Appropriate identification and management of this clinical problem are essential to prevent complications as well as subsequent malignant sequelae.

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“…Her palpitation was controlled with anti-thyroid medication and her subsequent TFT showed subclinical trend and normalized postdelivery. Hyperthyroidism occurred in the patient as extremely high level hCG had thyrotrophic activity because of structural similarity to thyroid stimulating hormone (TSH) (Swaminathan et al 2017). A hCG level greater than 200,000 mIU/ml has been found to suppress TSH (Virmani et al 2017).…”

Section: Twin Pregnancy Of Completementioning

confidence: 98%

Biochemical Derangement in Twin Pregnancy: Complete Hydatidiform Mole and Viable Foetus

Mansor¹

2018

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Kes kehamilan kembar molar bersama dengan kehamilan intrauterin yang normal adalah sangat jarang berlaku. Insiden kehamilan tersebut adalah sangat rendah dengan kadar satu kes di dalam 20,000-100,000 kelahiran. Kehamilan tersebut dikaitkan dengan risiko keguguran, kelahiran pramatang, kematian janin didalam rahim, pendarahan, pre-eklampsia, dan persistence trophoblastic disease (PTD). Kehamilan ini juga boleh mengakibatkan perubahan paras ujian biokimia di dalam ibu hamil dan mengakibatkan manifestasi gejala kepada ibu. Terdapat beberapa kes yang sama telah dilaporkan di kalangan penduduk Asia dengan dilema pengurusan klinikal yang signifikan kepada ibu dan janin. Di sini, kami laporkan kes seorang wanita muda dengan sejarah obstetrik yang kompleks hadir dengan masalah pendarahan per vagina di awal kehamilan. Beliau mempunyai kehamilan kembar molar hydatidiform lengkap dengan janin yang normal. Keadaan ini mengakibatkan paras ujian biokimia human chorionic gonadotrophin (hCG) yang sangat tinggi. Beliau juga mengalami hipertiroid. Selepas proses kelahiran, nilai hCG masih tinggi dan beliau didiagnosakan sebagai 'Gestational Trophoblastic Neoplasm'.

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Anaesthetic implications of severe hyperthyroidism secondary to molar pregnancy: A case report and review of literature

Cited by 12 publications

References 10 publications

Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

Advanced gestational trophoblastic disease: A case report of medical management prior to surgical intervention

Biochemical Derangement in Twin Pregnancy: Complete Hydatidiform Mole and Viable Foetus

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