Hyperthyroidism in men with germ cell tumors and high levels of beta-human chorionic gonadotropin.
A retrospective review was done on all high volume choriocarcinomas and other germ cell tumors of men with serum beta-human chorionic gonadotropin (beta-HCG) levels greater than 50,000 mIU/ml to determine the incidence and characteristics of hyperthyroidism in this setting. Nineteen patients were identified with high beta-HCG levels, but because 2 did not have thyroid function tests performed, the cases of only 17 patients were evaluable. Of these, 14 (82%) had primary testicular carcinoma and 3 (18%) had extragonadal tumors. Beta-HCG levels on presentation ranged from 80,000 to 3,058,000 mIU/ml, with a median of 243,500 mIU/ml. Seven of the 17 evaluable cases (41%) had T4 serum levels higher than 12 micrograms/dl (normal level 4 to 12 micrograms/dl) with a median value of 15.4 micrograms/dl (range, 12.6 to 33.5 micrograms/dl); serum T4 levels correlated with beta-HCG levels (r = 0.84). All seven patients with elevated T4 levels had beta-HCG values greater than 200,000 mIU/ml, and three of these seven had clinical manifestations that could be attributed to an elevated serum T4; only one patient required specific antithyroid treatment; and after control of primary disease, all other patients had normalization of thyroid function. The most common manifestations of hyperthyroidism in our series were tachycardia, hypertension, and a systolic flow murmur; none of the patients had thyroid gland enlargement. We conclude that subclinical hyperthyroidism is a relatively common phenomenon in germ cell tumors of men with high levels of beta-HCG and that control of the primary disease results in serum T4 level normalization.
Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
S A
SA
Giralt
F
F
Dexeus
R
R
Amato
A
A
Sella
C
C
Logothetis
D000293:Adolescent; D000328:Adult; D002822:Choriocarcinoma / Q000150:complications; D006063:Chorionic Gonadotropin / Q000378:metabolism*; D018997:Chorionic Gonadotropin, beta Subunit, Human; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000150:complications / Q000378:metabolism*; D013974:Thyroxine / Q000378:metabolism
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D013974:Thyroxine