Clinical hyperthyroidism in hydatidiform mole: case report

Authors

DOI:

https://doi.org/10.11606/issn.1679-9836.v100i1p84-89

Keywords:

Gestational trophoblastic disease, Hydatidiform mole, Hyperthyroidism

Abstract

Introduction: Gestational trophoblastic disease (GTD) is a group of diseases responsible for producing high hCG titers, which may lead to possible complications such as hyperthyroidism and, in more severe situations, the thyrotoxic crisis. Hyperthyroidism is present in only 5% of cases of GTD, and its early diagnosis is important. Case Report: A 49-year-old female patient, G6L2A3, presented to the emergency room reporting irregular vaginal bleeding for four months, hyperemesis, irritability, tremors, palpitations, xerostomia, and a history of recurrent miscarriages. Gynecological examination revealed coffee-ground type bleeding through the cervix’s external orifice, and at the bimanual touch, there was a pelvic mass above the umbilical scar. TVUS showed a uterine volume of 1302 cc³ and images corresponding to GTD. TSH and FT4 of 0.015 mU/L (RV: 0.4 - 4.5 mU/L) and 2.34 ng/dL (RV: 0.7 - 1.8 ng/dL) respectively, and BhCG plasma dosage > 225,000 mIU/mL. The physical examination showed a slightly enlarged thyroid of parenchymal consistency and a slightly exalted Achilles reflex. There was no family history of thyroid disease and negative screening for anti-TPO, anti-TG, and TRAb antibodies. The patient underwent Manual Intrauterine Aspiration. Due to the maintenance of high BhCG levels, a new TVUS was requested, which suggested GTD. Due to the high risk of neoplasia, absence of metastatic focus, and constituted offspring, it was decided to perform a total abdominal hysterectomy, with bilateral salpingectomy and preservation of the ovaries bilaterally, as a form of treatment. TSH normalized at 0.5 mU/L after surgery. The histopathology showed an Invasive Mole. Conclusion: Diseases with elevated hCG may lead to secondary hyperthyroidism. Although this condition is present in only 5% of cases of GTD, the physician cannot ignore the importance of his or her investigation for an early diagnosis to avoid more severe complications such as the thyrotoxic crisis.

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Author Biographies

  • Elis Camara Francischetto, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Acadêmica do 9º período de Medicina da Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES

  • Laís Veiga Campanharo, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Acadêmica do 9º período de Medicina da Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES

  • Alice Fernandes de Carvalho, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Acadêmica do 9º período de Medicina da Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES.

  • Rubens Bermudes Musiello, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Ginecologista e Obstetra. Possui especialização pela Santa Casa de Misericórdia do Rio de Janeiro (1989) e mestrado pela Universidade Federal de São Paulo (2011). Professor Assistente da Escola Superior de Ciências da Saúde da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES.

  • Rachel Torres Sasso, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Endocrinologista. Possui graduação em Medicina - Irmandade da Santa Casa de Misericórdia de Vitória (1986). Atualmente é endocrinologista do Hospital da Santa Casa de Misericórdia de Vitória, professora assistente - Irmandade da Santa Casa de Misericórdia de Vitória e endocrinologista - Consultório Particular - Dra. Rachel Torres Sasso. Tem experiência na área de Medicina, com ênfase em Endocrinologia Mestre em Políticas Públicas e Desenvolvimento Local.

  • Antônio Chambô Filho, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Ginecologista e Obstetra. Possui graduação em Medicina pela Escola Superior de Medicina da Santa Casa de Misericórdia de Vitória (1975), curso de Pós Graduação em Ginecologia e Obstetrícia no Hospital Clínico e Provincial da Universidade de Barcelona/Espanha no período de 1979 a 1982, Mestre em Medicina (Obstetrícia e Ginecologia pela Universidade Federal de Minas Gerais (1988) e Doutor em Medicina (Obstetrícia e Ginecologia pela Universidade Federal de Minas Gerais (2001). Professor titular de Ginecologia e Obstetrícia da Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES

  • Carmen Dolores Gonçalves Brandão, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

    Endocrinologista. Graduada em Medicina pela Escola Superior de Ciências da Saúde da Santa Casa de Misericórdia de Vitória (EMESCAM/1988), Mestre em Endocrinologia pela Universidade Federal do Rio de Janeiro (UFRJ/1992) e Doutora em Endocrinologia pela Universidade Federal do Rio de Janeiro (UFRJ/2006). Atualmente é Professor adjunto da cadeira de Endocrinologia e Metabologia da Escola Superior de Ciências da Saúde da Santa Casa de Misericórdia de Vitória (EMESCAM), médica endocrinologista da Prefeitura Municipal de Vitória e Consultório Médico.

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Published

2021-03-17

Issue

Vol. 100 No. 1 (2021)

Section

Relato de Caso/Case Report

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Copyright (c) 2021 Elis Camara Francischetto, Laís Veiga Campanharo, Alice Fernandes de Carvalho, Rubens Bermudes Musiello, Rachel Torres Sasso, Antônio Chambô Filho, Carmen Dolores Gonçalves Brandão

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How to Cite

Francischetto, E. C., Campanharo, L. V., Carvalho, A. F. de, Musiello, R. B., Sasso, R. T., Chambô Filho, A., & Brandão, C. D. G. (2021). Clinical hyperthyroidism in hydatidiform mole: case report. Revista De Medicina, 100(1), 84-89. https://doi.org/10.11606/issn.1679-9836.v100i1p84-89