Gestational choriocarcinoma and thyrotoxicosis

Anderson, Norwood; Lokich, Jacob J.; McDermott, William V.; Trey, Charles; Falchuk, Kenneth R.

doi:10.1002/1097-0142(197907)44:1<304::aid-cncr2820440151>3.0.co;2-r

Cited by 13 publications

(5 citation statements)

References 11 publications

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“…Some studies investigating the effect of high HCG titers on TSH and fT4 levels have shown that when the HCG titer increases above 200,000 IU/l, the probability of incidence of TSH suppression (TSH < 0.2 IU/l) is 67%, while at titers above 400,000 IU/l, TSH suppression reaches 100%. 17 , 18 , 19 In our study, contrary to the data in the literature, there were euthyroid patients with even the highest HCG values. Among the 30 patients with HCG values above 200,000 uIU/l, 17 (70%) began treatment for clear hyperthyroidism, while among the 20 patients with HCG above 400,000 uIU/l, 15 (71%) began treatment.…”

Section: Discussioncontrasting

confidence: 99%

Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study

Düğeroğlu

Özgenoğlu

2019

Sao Paulo Med. J.

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BACKGROUND: Gestational trophoblastic diseases (GTDs) are treatable rare tumors with wide distribution. The estimated incidence of GTDs varies dramatically between different regions globally. In early pregnancy, there may be high human chorionic gonadotropin (HCG) concentrations, normal or slightly increased free T4 (fT4) and subnormal thyroid-stimulating hormone (TSH), causing hyperthyroidism ranging from subclinical to severe. Beta-HCG causes thyrotoxicosis through thyroid stimulation in patients with trophoblastic tumors. OBJECTIVE: To assess thyroid function among patients diagnosed with complete or partial hydatidiform mole, within the GTD spectrum. DESIGN AND SETTING: Cross-sectional study based on patients' medical records at Van University Hospital, Van, Turkey. METHODS: 50 patients monitored due to diagnoses of hydatidiform mole were included and were examined regarding thyroid function. Thyroid gland size and volume were measured using thyroid ultrasonography. Beta-HCG, TSH, fT4, free T3 (fT3), total T4 (TT4), total T3 (TT3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and thyroglobulin levels were measured. RESULTS: Among these patients, 15 (30%) were diagnosed with complete hydatidiform mole and 35 (70%) with partial hydatidiform mole, according to pathology results. Those with complete hydatidiform mole were older (P = 0.003), with higher number of pregnancies (P = 0.032), lower TSH level (P = 0.011) and higher fT4 and TT4 levels (P = 0.04; P = 0.028), compared with partial hydatidiform mole patients. CONCLUSION: In hydatidiform mole patients, thyroid disease severity increases with age, parity, beta-HCG level and mole size. However, prospective multicenter studies on this topic are needed, with larger numbers of patients and closer monitoring. Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study | ORIGINAL ARTICLE

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Section: Discussioncontrasting

confidence: 99%

Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study

Düğeroğlu

Özgenoğlu

2019

Sao Paulo Med. J.

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“…Several regimens via propylthiouracil, propranolol, or Lugol's solution, for example, could be effective for counteracting the overactive thyroid function; nonetheless, all the above regimens were in vain for this patient, probably because of the extremely high hCG level which was unexpected. Used for underlying conditions refractory to conventional therapy, the EMA‐CO chemotherapy for patients with very high hCG titers has been very effective, except in a small population with thyrotoxicosis: 6–9 Only the first course relieved our patient's symptoms, and the second resulted in her reaching the euthyroid state before the hCG titer was normalized. After the normalization, two additional courses are usually compulsory for complete eradication of the cancer cells.…”

Section: Discussionmentioning

confidence: 90%

“…Though gestational trophoblastic diseases (GTD) in some patients display a marked elevation of serum T4, T3, and free T4 concentrations, clinical thyrotoxicosis is usually absent. Aside from choriocarcinoma as a cause of thyrotoxicosis, symptomatic evidence of increased thyroid function has been reported in approximately 6% of patients with choriocarcinoma, and it appears that serum hCG levels greater than 100 000 mIU/mL are required to produce clinical evidence of thyrotoxicosis 6–9 …”

Section: Discussionmentioning

confidence: 99%

Uterine choriocarcinoma accompanied by an extremely high human chorionic gonadotropin level and thyrotoxicosis

Hsieh

Hsu

Kuo

et al. 2008

J of Obstet and Gynaecol

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The conventional treatments given to a 24-year-old woman with metastatic uterine choriocarcinoma and clinical and biochemical thyrotoxicosis did not appear to have any effect, probably due to an extremely high serum human chorionic gonadotropin (hCG) level which was up to 11,910,000 mIU/mL, and were initially underscored in light of the 'high-dose hook effect'. To our knowledge, no extremely high hCG level in a uterine choriocarcinoma patient has been reported in the literature. Her decapacitating symptoms subsided after the first course of chemotherapy by etoposide, methotrexate, and actinomycin D-cyclophosphamide and vincristine (EMA-CO) regimen. The serum hCG level, which reflects the quantification of host tumor burden, returned to the reference range after the fifth course of chemotherapy and the thyroid function reached euthyroid status before the third course of chemotherapy; two final courses were administered after the hCG level became undetectable. Two years after remission of disease, the patient experienced a normal pregnancy, and a term baby girl was delivered vaginally. No recurrence of uterine choriocarcinoma has been noted for 7 years.

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“…It is also well documented that the biochemical markers of choriocarcinoma and of thyroid function parallel the regression of tumor. [3] After three weeks of chemotherapy, patient's hyperthyroid state was controlled partially and the CVS manifestations were also controlled significantly.…”

Section: Discussionmentioning

confidence: 95%