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Endocrine Abstracts (2024) 99 EP212 | DOI: 10.1530/endoabs.99.EP212

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Thyrotoxicosis in a molar pregnancy

Leah Antonette Tabuyo 1 & Hannah Corpuz 1


1Lorma Medical Center, Internal Medicine, San Fernando City, Philippines


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.

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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