title: Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.
abstract: BACKGROUND
  Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Patients with persistent disease require treatment with chemotherapy. For the vast majority, prognosis is excellent. Occasionally, GTD is complicated by hyperthyroidism, which may require treatment. This is thought to occur due to molecular mimicry between human chorionic gonadotrophin (HCG) and thyroid-stimulating hormone (TSH), and hence cross-reactivity with the TSH receptor. Hyperthyroidism usually resolves as the GTD is successfully treated and correspondingly HCG levels normalise.
  
  
  METHODS
  This paper reviews cases of GTD treated over a 5-year period at one of the three UK centres and identifies the prevalence of hyperthyroidism in this population. Four cases with clinical hyperthyroidism are discussed.
  
  
  RESULTS
  On review of the 196 patients with gestational trophoblastic neoplasia treated with chemotherapy in Sheffield since 2005, 14 (7%) had biochemical hyperthyroidism. Of these, four had evidence of clinical hyperthyroidism.
  
  
  CONCLUSIONS
  Concomitant biochemical thyroid disease in patients with GTD is relatively common, and measurement of thyroid function in patients with persistent GTD is, therefore, important. The development of hyperthyroidism is largely influenced by the level of HCG and disease burden, and usually settles with treatment of the persistent GTD. However, rarely the thyroid stimulation can have potentially life-threatening consequences.
authors.affiliation: Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield S10 2SJ, UK.
authors.forename: L
authors.initials: L
authors.lastname: Walkington
authors.forename: J
authors.initials: J
authors.lastname: Webster
authors.forename: B W
authors.initials: BW
authors.lastname: Hancock
authors.forename: J
authors.initials: J
authors.lastname: Everard
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D002231:Carbimazole / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000150:complications / Q000188:drug therapy; D006063:Chorionic Gonadotropin / Q000096:biosynthesis*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications; D006980:Hyperthyroidism / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D008875:Middle Aged; D011247:Pregnancy; D014594:Uterine Neoplasms / Q000150:complications
chemical_list: D013956:Antithyroid Agents; D006063:Chorionic Gonadotropin; D002231:Carbimazole