scholarly journals THYROTOXICOSIS IN PATIENTS WITH HYDATID MOLE

2021 ◽  
Vol 4 (1) ◽  
pp. 76
Author(s):  
Rahadianto Tjandra ◽  
Maimun Z. Arthamin
Keyword(s):  
Rare Case ◽  
Hydatidiform Mole ◽  
Age Groups ◽  
Sudden Onset ◽  
Thyroid Stimulating Hormone ◽  
Molar Pregnancy ◽  
Maternal Circulation ◽  
Free T4 ◽  
Long Period ◽  
Life Threatening

<p>Hydatid Mole, also often called grape pregnancy, is a pregnancy characterized by abnormal trophoblast development. The incidence of hydatidiform mole per 1,000 pregnancies occurs in Asia. In Indonesia, in 2002 cases of hydatidiform mole were found 1: 123 pregnancy, and in 2003 found cases of hydatidiform mole 1: 245 pregnancy. While the results of research conducted in the same place in 2012-2013 obtained 39 cases of hydatidiform mole that were distributed based on age groups, parity, education, and hemoglobin levels of patients. Trophoblastic hyperthyroidism is a rare case but can be life threatening. Alpha subunit-human chorionic gonadotropin (HCG) is similar to alpha sub-unit-thyroid stimulating hormone (TSH). If HCG concentrations increase over a long period of time, it can increase free T4 and free T3 levels. In this patient there was also a sudden onset of hypertension, proteinuria 3+, ketonuria 3+, hematuria 3+, leukosituria 1+, bacteriuria which could possibly be caused by the occurrence of a pre-eclampsia or UTI in this patient. The cause of pre-eclampsia in molar pregnancy is thought to be due to excessive levels of soluble fms-like tyrosine kinase 1 (sFlt1) in the circulation, an endogenous anti-angiogenic protein that enters the maternal circulation after overproduction in the placenta.</p><p><strong>Keywords: Mola hydatidosa, HCG, TSH, sFlt1</strong></p>

scholarly journals TSH enhancement of FT4 to FT3 conversion is age dependent

2016 ◽  
Vol 175 (1) ◽  
pp. 49-54 ◽  
Author(s):  
David Strich ◽  
Gilad Karavani ◽  
Shalom Edri ◽  
David Gillis
Keyword(s):  
Age Groups ◽  
Thyroid Stimulating Hormone ◽  
Older Age ◽  
Age Group ◽  
Free T4 ◽  
Free T3 ◽  
Age Related ◽  
Differential Increase ◽  
Retrospective Examination ◽  
Tsh Levels

ObjectiveWe previously reported increasing free T3 (FT3) to free T4 (FT4) ratios as thyroid-stimulating hormone (TSH) increases within the normal range in children. It is not known if this phenomenon is age-related among humans, as previously reported in rats. This study examines the relationships between TSH and FT3/FT4 ratios in different ages.DesignRetrospective examination of thyroid tests from patients without thyroid disease from community clinics.MethodsFree T3, free T4, and TSH levels from 527 564 sera collected from patients aged 1 year or greater were studied. Exclusion criteria were the following: missing data, TSH greater than 7.5mIU/L, and medications that may interfere with thyroid hormone activity. A total of 27 940 samples remaining after exclusion were stratified by age. Samples with available anthropometric data were additionally stratified for body mass index (BMI). Correlations of TSH to FT4, FT3, and FT3/FT4 ratios by age group were examined.ResultsUp to age 40, for each increasing TSH quartile, FT3 and the FT3/FT4 ratio increased and FT4 decreased significantly (for both FT3, FT4 and FT3/FT4 ratio,P<0.05 for every TSH quartile when compared with the 1st quartile, except FT3 in the 30–40 age group). In older age groups, increasing TSH was not associated with increased FT3/FT4 ratio.ConclusionAs TSH levels increase, FT3/FT4 ratios increase until age 40, but this differential increase does not occur in older age groups. This may reflect a decrease in thyroxine (T4) to triiodothyronine (T3) conversion with age, which may be part of the aging process.

scholarly journals KEHAMILAN KEMBAR DISERTAI MOLA HIDATIDOSA

2019 ◽  
Vol 8 (2) ◽  
pp. 75-83
Author(s):  
Harya Narottama ◽  
◽  
Erry Gumilar ◽  
Brahmana Askandar ◽  
◽  
...  
Keyword(s):  
Vaginal Bleeding ◽  
Rare Case ◽  
Twin Pregnancy ◽  
Ultrasound Examination ◽  
Hydatidiform Mole ◽  
Molar Pregnancy ◽  
Premature Labor ◽  
Triplet Pregnancy ◽  
Diagnostic Approaches

Twin pregnancy with Hydatidiform Mole is a rare case, only about 1 in 22.000 to 100.000 pregnancies. Molar pregnancy with triplet pregnancy is even rarer, which is only 6 cases reported and mostly occurred in women who received therapy for infertility. Management in cases of twin pregnancy with hydatidiform mole is dilemmatic both for the patient and physician. We present a case of 29 years old woman with her first pregnancy of twin fetuses complicated with hydatidiform mole. Diagnostic approaches were made mainly by ultrasound examination, continued with laboratory and radiology examinations which some did not performed due to worsened vaginal bleeding. This case ended with premature labor with the result of delivery of two babies and placenta with vesicles which is a characteristic of hydatidiform mole.

scholarly journals SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikoletta Proudan ◽  
Kersthine Andre
Keyword(s):  
Perioperative Complications ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
History Of

Abstract Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG &gt;100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period. A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (&lt; 5mlU/mL), TSH &lt;0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued. The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm. 1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

scholarly journals Spontaneous cardiac tamponade associated with dabigatran use in an elderly woman

2021 ◽  
Vol 2 (3) ◽  
pp. 27-30
Author(s):  
Anupam Bhambhani ◽  
Sahithi Sharma ◽  
Aditi Nadamani
Keyword(s):  
Risk Factors ◽  
Cardiac Tamponade ◽  
Rare Case ◽  
Early Morning ◽  
Sudden Onset ◽  
Anticoagulant Drugs ◽  
Life Threatening ◽  
Direct Anticoagulants ◽  
Dabigatran Therapy

We report here a rare case of dabigatran-related spontaneous cardiac tamponade, which appeared in absence of the known risk factors that predispose the patient to bleed related to anticoagulant drugs. A 65-year-old lady presented to the emergency room with sudden onset dyspnea which woke her up in the early morning hours. Four days earlier, she had been started on dabigatran therapy for DVT. On examination, she was in shock. Transthoracic echocardiography confirmed cardiac tamponade. Emergent pericardiocentesis was done, draining 480 ml of haemorrhagic fluid, which tested negative for microbes and malignant cells. The patient recovered rapidly and fluid did not re-accumulate after withdrawal of dabigatran therapy. Spontaneous cardiac tamponade is rare with the use of direct anticoagulants, especially dabigatran, in the absence of predisposing risk factors. This case study highlights the need for clinicians to be cognizant of this potentially life-threatening adverse drug reaction of dabigatran so that appropriate timely action can be taken toward diagnosis and management of this complication.

scholarly journals SUN-273 A Rare Case of IgG4-Related Hypophysitis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sindhura Ravindra ◽  
Pouneh Fazeli
Keyword(s):  
Plasma Cell ◽  
Rare Case ◽  
Systemic Disease ◽  
Sudden Onset ◽  
Pituitary Hormone ◽  
Mri Imaging ◽  
Free T4 ◽  
Central Hypothyroidism ◽  
Endoscopic Endonasal ◽  
Serum Igg4

Abstract Introduction: Hypophysitis is an acute or chronic inflammation of the pituitary gland and is an important diagnostic consideration in a patient with a sellar lesion. The annual incidence of hypophysitis is estimated to be 1 in 7–9 million and it accounts for approximately 0.4% of pituitary surgery cases. The following highlights a rare case of isolated IgG4-related hypophysitis Clinical Case: A 63-year-old Caucasian female presented with sudden onset of diplopia and decreased visual acuity. This was associated with a 3-month history of headaches and 5-lbs weight loss. Past medical history was significant for hypertension and a 1.5cm sellar/suprasellar mass incidentally discovered during the work-up for persistent headaches 1-month prior. Initial anterior pituitary hormone evaluation was normal and the patient was scheduled for endoscopic endonasal resection of a presumed non-functioning pituitary adenoma. Family history was negative for pituitary tumors or hyperparathyroidism. Physical examination was notable for medial deviation of her left eye but neurologic examination was otherwise normal. Laboratory studies were notable for a normal TSH [1.769 uIu/ml (normal: 0.3–5.0)] and low free T4 [0.44 ng/ml (normal: 0.89–1.78)] consistent with central hypothyroidism; an inappropriately normal FSH for a postmenopausal woman [5.6 mIu/ml (normal: 0.3–10.5), and a normal prolactin level [16 ng/ml (0.6–20)]. An 8am cortisol was low at 2mcg/dL (5–21) with an ACTH level of 10 pg/mL (9–46). IGF-1 was normal at 89 ng/mL (41–279). Repeat pituitary MRI imaging demonstrated a homogenously enhancing sellar/suprasellar mass measuring 3.8 cm with displacement of the optic chiasm. Serum IgG4 levels were normal. The patient was started on 50mg IV hydrocortisone every 8 hours for central adrenal insufficiency and levothyroxine 88 mcg daily for central hypothyroidism and underwent an endoscopic endonasal biopsy of the lesion. Surgical pathology was notable for plasma cell-rich lymphohistiocytic hypophysitis and IgG4 plasma cells constituted &gt;40% of the total plasma cell population. The patient subsequently received 1g of rituximab and repeat imaging one week later showed marked improvement in the size and extent of the lesion. The patient was discharged on prednisone and levothyroxine and received a second dose of rituximab at follow-up. The patient reports a decrease in the frequency of her headaches but continues to endorse diplopia. Conclusion: IgG4-related hypophysitis typically presents as part of a multifocal systemic process. This case highlights a rare entity of IgG4-related hypophysitis without other features of systemic disease and with normal serum levels of IgG4. Although glucocorticoids are universally regarded as the first line of therapy, an immunosuppressive agent or B-cell depletion therapy such as Rituximab may improve remission and decrease the risk of relapse.

scholarly journals Massive haemorrhage due to spontaneous rupture of a giant renal angiomyolipoma – report of a rare case and review of the literature

2019 ◽  
Vol 17 (3) ◽  
pp. 264-268
Author(s):  
Iv. Novakov
Keyword(s):  
Spontaneous Rupture ◽  
Rare Case ◽  
Sudden Onset ◽  
Massive Hemorrhage ◽  
Retroperitoneal Tumor ◽  
Severe Complication ◽  
Severe Bleeding ◽  
Renal Angiomyolipoma ◽  
Retroperitoneal Hemorrhage ◽  
Life Threatening

Massive hemorrhage due to spontaneous rupture of a renal angiomyolipoma is a rare, but the most severe complication of this unusual tumor. The aim of this publication is to present a rare case of massive retroperitoneal hemorrhage and hemoperitoneum due to spontaneous rupture of giant renal angiomyolipoma. Case presentation: A 20-year-old woman, with a previous diagnosis of tuberous sclerosis and sudden onset of severe abdominal pain is presented. Median laparotomy on emergency was performed, with operative finding of hemoperitoneum and a giant ruptured retroperitoneal tumor with retroperitoneal hematoma. Gross pathology and histological examination determined the origin of the retroperitoneal tumor mass – angiomyolipoma, complicated with rupture and severe bleeding. In conclusion, this case presents rare, but the most severe complication of renal angiomyolipomas – spontaneous rupture of the tumor with life-threatening retroperitoneal bleeding.

scholarly journals Delivery of Euthyroid Baby following Hyperthyroidism in Twin Gestation with Coexisting Complete Hydatidiform Mole

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Rishi Raj ◽  
Edilfavia Mae Uy ◽  
Matthew Hager ◽  
Kamyar Asadipooya
Keyword(s):  
Twin Pregnancy ◽  
Molecular Mimicry ◽  
Rare Complication ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Stimulating Hormone ◽  
Dose Titration ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Normal Fetus

Context. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description. A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions. Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.

Thyroid Function in Gestational Trophoblastic Tumors

1986 ◽  
Vol 72 (2) ◽  
pp. 205-209
Author(s):  
Franca Vergadoro ◽  
Laura Tabacchi ◽  
Pietro Barbacini ◽  
Laura Vassena ◽  
Flavia Zanaboni ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Thyroid Stimulating Hormone ◽  
Control Group ◽  
Free T4 ◽  
Free T3 ◽  
Normal Limits ◽  
Trophoblastic Tumors

Thyroid function was assessed in a total of 15 cases, 7 of whom had choriocarcinoma and 8 hydatidiform mole, by measuring free T3, free T4, thyroxin-binding globulin (TBG), basal thyroid-stimulating hormone (TSH) and after the thyrotropin-releasing hormone test (ΔTSH). Free T3, free T4 and TBG were investigated in the same number of healthy women within the first three months of pregnancy. Only 13.4% of the cases presented elevated levels of free T3 and T4 and TBG; TSH and ΔTSH were within normal limits. Both thyroid hormones and TBG returned to within normal limits when β-human chorionic gonadotropin became undetectable. One patient was found to be hypothyroid. Comparison with the control group showed no significant differences except in TBG levels, which were higher in controls. A significant, direct correlation was found between levels of free T3 and T4 and TBG and the pattern of human chorionic gonadotropin.

scholarly journals Multiple endocrinopathies, hypercalcaemia and pancreatitis following combined immune checkpoint inhibitor use- case report and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christine Newman ◽  
Oratile Kgosidalwa ◽  
Osamah A. Hakami ◽  
Carmel Kennedy ◽  
Liam Grogan ◽  
...  
Keyword(s):  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Lung Metastases ◽  
Incidental Finding ◽  
Oral Prednisolone ◽  
Thyroid Stimulating Hormone ◽  
Free T4 ◽  
Cross Sectional ◽  
Remarkable Case ◽  
Acth Deficiency

Abstract Background Immune checkpoint inhibitors (ICIs) are a novel class of oncological agents which are used to treat a number of malignancies. To date seven agents have been approved by the Food and Drug Administration (FDA) to treat both solid and haematological malignancies. Despite their efficacy they have been associated with a number of endocrinopathies. We report a unique case of hypophysitis, thyroiditis, severe hypercalcaemia and pancreatitis following combined ICI therapy. Case presentation A 46-year old Caucasian female with a background history of malignant melanoma and lung metastases presented to the emergency department with lethargy, nausea, palpitations and tremors. She had been started on a combination of nivolumab and ipilimumab 24 weeks earlier. Initial investigations revealed thyrotoxicosis with a thyroid stimulating hormone (TSH) of < 0.01 (0.38–5.33) mIU/L, free T4 of 66.9 (7–16) pmol/.L. TSH receptor and thyroperoxidase antibodies were negative. She was diagnosed with thyroiditis and treated with a beta blocker. Six weeks later she represented with polyuria and polydipsia. A corrected calcium of 3.54 (2.2–2.5) mmol/l and parathyroid hormone (PTH) of 9 (10–65) pg/ml confirmed a diagnosis of non-PTH mediated hypercalcaemia. PTH-related peptide and 1, 25-dihydroxycholecalciferol levels were within the normal range. Cross-sectional imaging and a bone scan out ruled bone metastases but did reveal an incidental finding of acute pancreatitis – both glucose and amylase levels were normal. The patient was treated with intravenous hydration and zoledronic acid. Assessment of the hypothalamic-pituitary-adrenal (HPA) axis uncovered adrenocorticotrophic hormone (ACTH) deficiency with a morning cortisol of 17 nmol/L. A pituitary Magnetic Resonance Image (MRI) was unremarkable. Given her excellent response to ICI therapy she remained on ipilimumab and nivolumab. On follow-up this patient’s thyrotoxicosis had resolved without anti-thyroid mediations – consistent with a diagnosis of thyroiditis secondary to nivolumab use. Calcium levels normalised rapidly and remained normal. ACTH deficiency persisted, and she is maintained on oral prednisolone. Conclusion This is a remarkable case in which ACTH deficiency due to hypophysitis; thyroiditis; hypercalcaemia and pancreatitis developed in the same patient on ipilimumab and nivolumab combination therapy. We postulate that hypercalcaemia in this case was secondary to a combination of hyperthyroidism and secondary adrenal insufficiency.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

Sign in / Sign up

Export Citation Format

Share Document