妊娠滋养细胞疾病导致的甲亢:妊娠滋养细胞疾病引起的甲状腺毒症:妊娠甲状腺毒症治疗中尚未满足的需求。

IF 0.9 Q4 ENDOCRINOLOGY & METABOLISM Case Reports in Endocrinology Pub Date : 2024-08-29 eCollection Date: 2024-01-01 DOI:10.1155/2024/5318871
Kalyan Mansukhbhai Shekhda, Vladislav Zlatkin, Bernard Khoo, Eleni Armeni
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引用次数: 0

摘要

妊娠期甲状腺毒症非常罕见,但如果不及时诊断和治疗,会对母亲或胎儿造成严重的不良后果。它可能由潜在的甲状腺疾病引起,也可能发展为妊娠期一过性甲状腺毒症。恶性妊娠是一种以滋养细胞异常增殖为特征的病理状态,可表现为良性或恶性,其诊断依据是β-hCG(β-人绒毛膜促性腺激素)不成比例的升高,以及超声波检查的特殊特征,包括无囊、大的多囊或蜂窝状外观。由于β-hCG和促甲状腺激素(TSH)在结构上相似,β-hCG水平的明显升高可引发甲状腺功能亢进,但β-hCG的促甲状腺作用在不同的妊娠滋养细胞疾病(GTD)患者中可能有所不同。在本报告中,我们介绍了两个病例(患者 1:43 岁;患者 2:31 岁),他们因阴道点滴出血、心悸和孕吐病史来到急诊科就诊。两名患者的血液化验结果均显示,β-hCG 水平异常升高,游离 T4(FT4)和游离 T3(FT3)水平较高,促甲状腺激素(TSH)水平也受到抑制。超声波检查显示,受孕产物无法存活,并伴有大面积多囊出血性病变和空孕囊,从而证实了GTD。Burch-Wartofsky评分量表的评分分别为20分和15分,这表明她们在发病时出现甲状腺风暴的可能性较小。医生给她们服用了抗甲状腺药物,然后排出了受孕产物。术后,她们的甲状腺功能恢复正常。这些病例强调了在接受手术治疗前排除甲状腺风暴、监测甲状腺功能和适当治疗甲状腺功能亢进的重要性。此外,考虑到β-hCG的甲状腺营养作用在确诊的GTD患者中存在差异也很重要。除了监测游离甲状腺激素水平外,考虑临床症状对有效处理此类病例也至关重要。
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Thyrotoxicosis due to Gestational Trophoblastic Disease: Unmet Needs in the Management of Gestational Thyrotoxicosis.

Thyrotoxicosis during pregnancy is rare but can have severe adverse consequences for the mother or foetus if left undiagnosed and untreated. It can be caused by an underlying thyroid disease or develop as gestational transient thyrotoxicosis. Molar pregnancy stands out as a pathological condition characterized by abnormal trophoblastic cell growth, which can manifest in benign or malignant forms, and is diagnosed with a disproportionate elevation of β-hCG (beta-human chorionic gonadotrophin) and specific features on ultrasonography including absent sac and large multicystic or honeycomb appearance. A pronounced increase in β-hCG levels can trigger hyperthyroidism, due to the structural resemblance between β-hCG and thyroid-stimulating hormone (TSH), although the thyrotrophic effects of β-hCG could vary between patients diagnosed with gestational trophoblastic disease (GTD). In this report, we present two cases (Patient 1: 43 years, Patient 2: 31 years) who came to emergency department following a history of vaginal spotting, palpitations, and hyperemesis. In both patients, blood tests indicated disproportionately elevated β-hCG levels along with high levels of Free T4 (FT4) and Free T3 (FT3), as well as suppressed TSH levels. Ultrasonography showed nonviable products of conception with large multicystic hemorrhagic lesions and empty gestational sacs, thereby confirming GTD. The Burch-Wartofsky Point Scale scores were 20 and 15 points, respectively, suggesting that they were less likely to be in thyroid storm at presentation. Antithyroid medications were administered, followed by evacuation of the products of conception. Postoperatively, their thyroid function was normalized. These cases underscore the importance of ruling out thyroid storm, monitoring thyroid function, and treating hyperthyroidism appropriately before undergoing surgical treatment. It is also important to consider the variability in the thyrotrophic effects of β-hCG among individuals diagnosed with GTD. In addition to monitoring free thyroid hormone levels, it is crucial to consider clinical symptoms to effectively manage such cases.

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来源期刊
Case Reports in Endocrinology
Case Reports in Endocrinology ENDOCRINOLOGY & METABOLISM-
CiteScore
2.10
自引率
0.00%
发文量
45
审稿时长
13 weeks
期刊最新文献
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