Journal List > J Korean Soc Endocrinol > v.20(3) > 1063793

Yoo, Moon, Park, Lee, Jeong, Hong, Oh, Kim, Kim, Yoo, Ihm, Choi, Yoo, Park, and Min: A Case of Hashimoto's Thyroiditis with Transient T3-Thyrotoxicosis Induced by Hydatidiform Mole

Abstract

Human chorionic gonadotropin (HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits (alpha(α) and beta(β)). The α- and β-subunits have a structural homology with the α- and β-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so β-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess β-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism.
It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by β-HCG, due to an H-mole.

Figures and Tables

Fig. 1
Pelvis MRI shows uterus enlargement (11×8×12 cm) and tiny cystic mass was filled in uterine cavity. The mass shows T1 low-T2 bright signal intensity and mesh-like enhancement.
jkse-20-294-g001
Fig. 2
Microscopic findings of endometrium shows hyperplastic trophoblasts on edematous enlarged villi (H&E, ×40)
jkse-20-294-g002
Fig. 3
Time course of serum thyroid hormone, TSH and β-HCG
jkse-20-294-g003
Fig. 4
Thyroid aspiration cytology shows some follicular cells showing small sized nuclei with smooth membrane and abundant cytoplasm. Many lymphocytes are scattered (Pap, ×200)
jkse-20-294-g004

References

1. Tisne L, Barzellato J, Stevenson C. Study of thyroid function during pregnancy and the postpartum period with radioactive iodine. Bol Soc Chil Obstet Gynecol. 1955. 20:246. Cited form 23.
3. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid. 1995. 5:425–434.
4. Azukizawa M, Kurtzman G, Pekary AE, Hershman JM. Comparison of the binding characteristic of bovine thyrotropin and human chorionic gonadotropin to thyroid plasma membranes. Endocrinology. 1977. 101:1990.
5. Carayon P, Lefort G, Nisula B. Interaction of human chorionic gonadotropin and human luteinizing hormone with human thyroid membranes. Endocrinology. 1980. 106:1907.
6. Nisula BC, Taliadouros GS. Thyroid function in gestational trophoblastic disease: evidence that the thyropropic activity of chorionic gonadotropin mediates the thyrotoxicosis of choriocarcinoma. Am J Obstet Gynecol. 1980. 138:77–85.
7. Kenimer JG, Hershman JM, Higgins HP. The thyrotropin in hydatidiform moles is human chorionic gonadotropin. J Clin Endocrinol Metab. 1975. 40:482.
8. Hershman JM. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab. 2004. 18:249–265.
10. Fantz CR, Dadago-Jack S, Landerson JH, Gronowski AM. Thyroid Function during Pregnancy. Clinical Chemistry. 1999. 45(12):2250–2258.
11. Hershman JM. Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumor. Thyroid. 1999. 9:653–657.
15. Hershman JM. Braverman LE, editor. Trophoblastic tumor. The thyroid. 2004. 9th ed. Philadelphia: Lippincott Williams & Wilkins;519–523.
TOOLS
Similar articles