GESTATIONAL TROPHOBLASTIC NEOPLASIA (GTN) WITH HYPERTIROIDISM (CASE REPORT)

Devi Rahmadhona, Betty Agustina Tambunan

Abstract


Introduction. Gestationaltrophoblastic neoplasia(GTN) is a malignant lesion arising from placental villous and extra-villous trophoblast, occuring in 1:40,000 pregnancies. Invasive mole and choriocarcinoma are the vast majority of GTN, produce substantial amounts of human chorionic gonadotropin (hCG). Hyperthyroidism in GTN is due to stimulation of thyroid gland by hCG which has a similar structure with thyroid stimulating hormone (TSH).

Case. A 28-year-old female, suspected with choriocarcinoma and anemia, had history of recurrent vaginal bleeding in 8 months, accompanied with loss of appetite, weight loss, palpitation and tremor. Physical examination: pulse rate 114x/minutes, respiration rate 26x/minutes, temperature 38 0C, conjunctival anemia and dyspneu. Laboratory: anemia, leukocytosis, hypoalbuminemia, hypokalemia, increase ofLDH, increase of bhCG >1,500,000 mIU/mL, T4 14.1 ug/dL (4.40-10.90 ug/dL), FT4 1.95 ng/dL (0.89-1.76 ng/dL), and decrease of TSH. Abdominal CT Scan suggested uterine mass suspected as malignancy infiltrating to rectum with metastatic features in 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.

Discussion.GTN diagnostic criteria include: increased bhCG examined ³4 x; increased bhCG ³3 weekly examination; histology diagnosis of choriocarcinoma; increased bhCG > 20,000 more than 4 weeks post evacuation and the presence of metastasis. Hyperthyroidism in GTN is potentially life threatening because of heart failure and thyroid storm.

Conclusion.Hyperthyroidism increases morbidity and mortality in GTN patient, so periodic thyroid examination is essential to prevent further complication of hyperthyroidism.

 

 


Keywords


Key words: Gestational trophoblastic neoplasia (GTN), Human chorionic gonadotropin (hCG), hyperthyroidism



DOI: http://dx.doi.org/10.24293/ijcpml.v26i2.1428

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