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

J Korean Soc Endocrinol. 2005 Jun;20(3):294-298. Korean.
Published online June 30, 2005.  https://doi.org/10.3803/jkes.2005.20.3.294
Copyright © 2005 Korean Endocrine Society
A Case of Hashimoto's Thyroiditis with Transient T3-Thyrotoxicosis Induced by Hydatidiform Mole
Ji Youn Yoo, Hong Ju Moon, Cheol Young Park, Seong Jin Lee, In Kyung Jeong, Eun Gyung Hong, Gi Weon Oh, Hyeon Kyu Kim, Doo Men Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park and Soo Kee Min
Department of lnternal Medicine and Pathology, College of Medicine, Hallym University, Chunchon, Korea.
Received March 15, 2004; Accepted April 08, 2005.

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.

Keywords: Hashimoto's thyroiditis; T3-thyrotoxicosis; Hyperthyroidism; GTD (Gestational trophoblastic disease); H-mole

Figures


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.
Click for larger image


Fig. 2
Microscopic findings of endometrium shows hyperplastic trophoblasts on edematous enlarged villi (H&E, ×40)
Click for larger image


Fig. 3
Time course of serum thyroid hormone, TSH and β-HCG
Click for larger image


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)
Click for larger image

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. Trophoblastic tumor. In: Braverman LE, editor. The thyroid. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. pp. 519-523.