THYROTOXICOSIS SECONDARY TO A MOLAR PREGNANCY

Abstract

CASE
Rarely, hydatidiform moles (H-moles) may cause thyrotoxicosis due to the homology of excessively secreted placental human chorionic gonadotropin (hCG) with TSH. A 46-year-old Filipino female presented with tachycardia, hypertension (250/120 mmHg), b-hCG >10,000 mIU/mL, suppressed TSH 0.006 mIU/L, and high FT3 19.04 pg/mL (NV: 2.02 - 4.43) and FT4 7.77 ng/dL (NV: 0.93 - 1.71). The 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 was discontinued and she was discharged stable. On follow-up, hCG decreased to 1021 mIU/mL, and she was euthyroid (FT4 9.27 pmol/L). This case highlights an uncommon etiology of thyrotoxicosis which requires early recognition and intervention. Molar evacuation is the definitive treatment. To date, there are no existing guidelines with regard to the use of anti-thyroid medications perioperatively.