Delivery of Euthyroid Baby following Hyperthyroidism in Twin Gestation with Coexisting Complete Hydatidiform Mole

Abstract

Context. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description. A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions. Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.

Complete molar pregnancy with coexisting normal twin complicated by hyperthyroidism that resulted in normal alive delivery: A case report from Wolaita Sodo, Ethiopia

“…hCG and TSH share a molecular resemblance that leads to gestational trophoblastic hyperthyroidism, which is also linked to an increase in maternal and fetal problems. 28 In our case, she had gestational trophoblastic hyperthyroidism, for which she was treated with thioamide and beta-blocker, underwent inpatient follow-up and care, and improved and gave birth to alive euthyroid newborn. Some authors reported an increased risk of severe preeclampsia (25.8%) in complete hydatidiform mole with a coexisting live fetus, while others found no significant differences with singleton complete molar.…”

“…hCG and TSH share a molecular resemblance that leads to gestational trophoblastic hyperthyroidism, which is also linked to an increase in maternal and fetal problems. 28 In our case, she had gestational trophoblastic hyperthyroidism, for which she was treated with thioamide and beta-blocker, underwent inpatient follow-up and care, and improved and gave birth to alive euthyroid newborn.…”

Maternal thyroid function in multiple pregnancies – a systematic review

“…Molar pregnancies were not included in this review due to their different pathophysiology. Such patients face a considerable risk of developing severe hyperthyroidism constituting one of the main challenges for caregivers ( 49 , 50 ).…”

Management of a complete hydatidiform mole with a coexisting live fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease: learning points

“…Complete hydatidiform mole with a coexisting live fetus (CHMCF) is a rare condition. The estimated incidence is 1 per 22 000–100 000 pregnancies 1 2. In absolute terms, a study by Rohilla3 in 2015 found 177 documented cases with consequent 66 live births to date.…”