Endocrine Abstracts

Hydatidiform moles are categorized as either complete or partial and can only be confirmed by karyotyping. Complete moles are more frequently associated with medical complications such as hyperthyroidism. A 46-year-old Filipino female presented with tachycardia, hypertension, b-hCG > 10,000 mIU/ml, suppressed TSH 0.006 mIU/l, high FT3 19.04 pg/ml (NV: 2.02 - 4.43) and FT4 7.77 ng/dL (NV: 0.93 - 1.71). Uterus was enlarged with contractions. Antihypertensives and Propylthiouracil (PTU) were given to facilitate urgent hysterectomy due to profuse bleeding. Post-operatively, FT4 decreased (3.94 ng/dl). Antihypertensives were continued, PTU discontinued and she was discharged stable. On follow-up, hCG decreased to 1021 mIU/ml, and she was euthyroid (FT4 9.27 pmol/L). Mechanisms of molar pregnancy-induced hyperthyroidism:- structural similarity of hCG and TSH molecules and their receptors provides the basis for the thyrotropic action of hCG- "spillover effect" which refers to a phenomenon where hormones that are not intended to act on a particular receptor can still bind to it and produce an effect- the hCG found in hydatidiform moles lack the C- terminus and contain lower sialic acid which cause greater stimulation of the TSH receptor Reports have shown that hyperthyroid symptoms become apparent once ?-hCG levels reach 200,000 m[IU]/ml. It has been estimated that for every 10,000 m[lU]/ml increase in serum hCG, TSH decreases by 0.1 mlU/ml and free T4 increases by 0.1 ng/dThis case highlights an important yet uncommon etiology of thyrotoxicosis. Clinical presentation varies from asymptomatic to life-threatening thyroid storm, hence, early recognition and prompt intervention are essential to prevent disease progression. Molar evacuation is the definitive treatment. B-hCG titers and thyroid hormones are expected to normalize after. Up to date, there are no existing guidelines with regard to the use of anti-thyroid medications prior to or after surgery. Further studies are needed to deepen our understanding of this condition to improve early detection, optimize management, and reduce associated complications.