Molar pregnancy and thyroid storm - literature review

Filipescu, G; Solomon, Oana; Clim, Nicoleta; Milulescu, Amelia; Boiangiu, Andreea; Mitran, Madalina-Irina

doi:10.1515/arsm-2017-0021

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Thyroid storm is the most severe and life-threatening condition in thyrotoxicosis. 1,12 There is a case of thyroid storm that occurred after mild hydatidiform mole evacuation. This is due to inflammation in the evacuation process will cause increased metabolism thus triggering the production of more thyroid hormone.…”

Section: Discussionmentioning

confidence: 99%

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Nugraha

Samodro²

2019

JKKI

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Thyrotoxicosis defined as a clinical manifestation of excess circulating thyroid hormone. Epidemiologic investigation reports 0.2% of thyrotoxicosis is caused by hydatidiform mole. The New England Trophoblastic Disease Centre (NETDC) mentioned that 20% of hydatidiform mole cases have thyrotoxicosis as one of its complications. The basic pathogenesis of thyrotoxicosis is the similarity of the HCG subunit to TSH which results in excessive stimulation of thyroid hormone. We present thethyrotoxicosis case in a 15-weeks pregnant woman with complete hydatidiform mole. The patient admitted to the hospital with blackish-red coloured bleeding and several hyperthyroidism complaints, laboratory test showed elevated levels of HCG and thyroid hormone and decreased TSH. Imaging studies done with ultrasound showed with snowflake pattern. The patient then treated with thyroid hormone suppressant therapy before the hydatidiform mole evacuation. Normalization of thyroid hormone levels should be made immediately before the mole evacuation to avoid lifethreatening thyroid storm complications. Tirotoksikosis merupakan manifestasi klinis akibat kelebihan hormon tiroid yang beredar dalam darah. Hasil epidemiologi mencatat sekitar 0,2% kasus tirotoksikosis dapat disebabkan oleh mola hidatidosa. The New England Thropoblastic Disease Centre (NETDC) menyebutkan 20% kasus mola hidatidosa di benua Asia memiliki komplikasi tirotoksikosis. Patofisiologi dasar tirotoksikosis adalah kemiripan subunit HCG dengan TSH yang mengakibatkan stimulasi produksi hormon tiroid yang berlebihan. Pada kesempatan ini dilaporkan sebuah kasus tirotoksikosis pada seorang wanita hamil usia 15 minggu dengan mola hidatidosa komplit. Pasien mengeluh perdarahan banyak berwarna merah kehitaman, disertai beberapa keluhan hipertiroidisme, hasil laboratorium menunjukkan peningkatan kadar HCG dan hormon tiroid, penurunan TSH disertai gambaran snowflake pattern pada hasil USG. Pasien kemudian diberikan terapi penekan hormon tiroid sebelum dilakukan evakuasi mola. Penekanan kadar hormon tiroid harus dilakukan segera sebelum tindakan evakuasi mola agar komplikasi badai tiroid yang dapat mengancam keadaan pasien dapat dicegah.

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Section: Discussionmentioning

confidence: 99%

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Nugraha

Samodro²

2019

JKKI

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“…Early invasive focal molar malplacentation is associated with a previous uterine operation or inflammation, and the goal of conservative therapy is to preserve the uterus and fertility. Rare cases of preserved fertility after detection of invasive molar pregnancy, evacuation, or systemic/focal methotrexate therapy have been described in the literature 1 2 3 . In the presence of persistent bleeding with a clear Doppler finding of residual chorion/molar tissue and myometrial invasion to the serosa, surgical or drug treatment or combination therapy should be carefully considered until symptoms resolve or a reassuring ultrasound finding is obtained.…”

Section: Commentarymentioning

confidence: 99%

Invasive Mole After Incomplete Miscarriage

Habek

2022

Z Geburtshilfe Neonatol

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Case presentationA 33-year-old healthy woman with two previous deliveries and a history of spontaneo us miscarriage with uterine curettage experienced a new spontaneous incomplete miscarriage in the 14 th week of pregnancy. When admitted to the emergency department, the patient was bleeding heavily from the vagina, with the vital signs being normal. Transvaginal ultrasound and color Doppler imaging detected an inhomogeneous intrauterine mass with an invasive mole in the destroyed posterior uterine wall (mola destruens; ▶Fig. 1a). Blood counts indicated mild anemia, and β-hCG was 3220 U/l. Based on these findings, a hysteroscopic resection of the intrauterine mass was performed without extending surgery to the destroyed uterine wall, to avoid the risk of possible uterine perforation (▶Fig. 1b). The operation was performed with the application of an intracavitary hemostatic sponge and 1 g intravenous tranexamic acid, without further bleeding. After uterine evacuation with uterotonics, owing to the slow decline in the concentration of β-hCG, conservative treatment with metho trexate/leucovorin was given. The complete regression of the Doppler signal of myometrial invasive infiltration and the absence of β-hCG secretion were monitored for one month. Pathohistology revealed a molar trophoblastic degeneration. Bibliography

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“…Molar pregnancy in postmenopausal women is a rare occurrence [ 3 ]. To date, there are only a small number of case studies and case series published in the previous literature about the gestational trophoblastic disease and hyperthyroidism [ 4 , 5 ]. Even rarer are the case reports of thyroid storm and benign trophoblastic disease in perimenopausal women [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Thyroid Storm Caused by a Complete Hydatidiform Mole in a Perimenopausal Woman

Jayasuriya

Muthukuda

Dissanayake

et al. 2020

Case Reports in Endocrinology

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Background. Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma is a rare cause of hyperthyroidism due to excess production of placental human chorionic gonadotrophin hormone (hCG) by tumor cells. Molecular mimicry between hCG and thyroid stimulating hormone (TSH) leads to continuous stimulation of TSH receptor by extremely high levels of hCG seen in these tumors. Consequently, biochemical and clinical hyperthyroidism ensues and it is potentially complicated by thyrotoxic crisis which is fatal unless urgent therapeutic steps are undertaken. Case Description. We present a 49-year-old perimenopausal woman who presented with recurrent thyroid storm and high output cardiac failure. The initial workup revealed suppressed TSH, high-free thyroxine (FT4), and free triiodothyronine (FT3) levels with increased vascularity of the normal-sized thyroid on ultrasonography. She was managed with parenteral beta blockers, steroids, and high-dose carbimazole. Her lower abdominal tenderness led to further investigations which revealed tremendously elevated beta-hCG and a snow storm appearance on transabdominal ultrasound suggestive of GTD. She underwent curative surgery and was diagnosed with complete hydatidiform mole postoperatively by histology. Conclusion. Recurrent thyroid crisis in gestational trophoblastic disease is an exceedingly rare presentation and that is highly fatal. This case highlights the importance of early detection and treatment of the etiology of thyrotoxicosis to eliminate mortality.

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Molar pregnancy and thyroid storm - literature review

Cited by 4 publications

References 22 publications

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Case study: Thyrotoxicosis on women with complete hydatidiform molar pregnancy

Invasive Mole After Incomplete Miscarriage

Recurrent Thyroid Storm Caused by a Complete Hydatidiform Mole in a Perimenopausal Woman

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