Gestational Trophoblastic Neoplasia with Hyperthyroidism

Devi Rahmadhona, Betty Agustina Tambunan


Gestational Trophoblastic Neoplasia (GTN) is a malignant lesion arising from placental villous and extra-villous
trophoblastand occurs in 1:40,000 pregnancies. Invasive mole and choriocarcinoma are the vast majority of GTN which
produce substantial amounts of Human Chorionic Gonadotropin (hCG). Hyperthyroidism in GTN is due to the stimulation of
the thyroid gland by hCG which has a similar structure with Thyroid-Stimulating Hormone (TSH). A 28-year-old female,
suspected with choriocarcinoma and anemia, had a history of recurrent vaginal bleeding for eight months, accompanied
with loss of appetite, weight loss, palpitation, and tremor. Physical examination such as pulse rate of 114x/minutes, the
0 respiration rate of 26x/minutes, temperature 38 C, conjunctival anemia, and dyspnea were reported. In addition, laboratory
findings such as anemia, leukocytosis, hypoalbuminemia, hypokalemia, increase of LDH, increase of hCG >1,500,000
mIU/mL, T4 levels of 14.1 ug/dL (4.40-10.90 ug/dL), FT4 levels of 1.95 ng/dL (0.89-1.76 ng/dL), and decrease of TSH were also
reported. Abdominal CT Scan suggested uterine mass suspected as malignancy infiltrating to the rectum with metastatic
features in the liver, base of left lung, spleen and left kidney. Increased CA-125, and metastatic features of lung right
paracardial and left suprahilar from Chest X-ray were found. Diagnostic criteria for gestational trophoblastic neoplasia are as
follows: increased hCG 4 x tests; increased hCG three weekly tests; histology diagnosis of choriocarcinoma; increased hCG
> 20,000 more than four weeks post evacuation and the presence of metastasis. Hyperthyroidism in GTN is potentially
life-threatening because of heart failure and thyroid storm. Hyperthyroidism increases morbidity and mortality in GTN
patient; therefore, periodic thyroid tests is essential to prevent further complication of hyperthyroidism.


Gestational trophoblastic neoplasia, human chorionic gonadotropin, hyperthyroidism

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