Endocrine Abstracts

We describe a 40-year-old female who presented with fine tremors, weight loss, dyspnea and hemoptysis. On examination she appeared diaphoretic and tachycardic without goiter or thyroid eye disease. Thyroid function tests confirmed biochemical hyperthyroidism: [fT4 >100 pmol/l (NR: 12–22), TSH <0.005 mu/l (NR: 0.270–4.200)]. Chest X-ray showed numerous metastatic pulmonary nodules bilaterally. CT chest confirmed multiple large pulmonary metastases throughout both lung fields. Biochemical assays confirmed B-HCG level of 729 013 IU/l (N : <5 IU/l). Patient was admitted as a case of hyperthyroidism associated with elevated β-human chorionic gonadotropin (B-HCG) and diffuses lung metastases highly suggestive of metastatic disease. Hyperthyroidism was treated with Carbimazole and propranolol. CT scan of abdomen and pelvis showed the whole uterine body is being replaced by a mass increasing the size of the uterus to measure around 10×11×9 cm. Patient underwent hysterectomy, pathology report confirmed diagnosis of uterine choriocarcinoma. Chemotherapy (dactinomycin, etoposide) was initiated for uterine choriocarcinoma. After the second cycle of chemotherapy, the concentration of B-HCG dramatically decreased and the patient became euthyroid, allowing us to discontinue antithyroid medication. This case illustrates the rare occurrence of thyrotoxicosis secondary to uterine choriocarcinoma. The patient's hyperthyroidism was triggered by stimulation of the thyroid gland by high B-HCG levels, as shown by the marked improvement of the thyroid function after surgical resection of uterine choriocarcinoma and chemotherapy.