title: [Two Cases of Germ Cell Tumors with Hyperthyroidism Due to High Serum hCGLevels].
abstract: We reported two cases of hyperthyroidism that developed during induction chemotherapy for advanced germ cell tumors with high serum human chorionic gonadotropin (hCG) levels. Case 1 : An 18-year-old man with mediastinal choriocarcinoma complained of tachycardia and tremor. His pretreatment serum hCG level was 1.37 million mIU/ml. The free thyroxine (fT4) level measured on day 2 of the first course of bleomycin, etoposide and cisplatin (BEP) was elevated to 7.8 ng/dl (＜1.7 ng/dl), whereasthe thyroidstimulating hormone (TSH) level was undetectable. We diagnosed the patient with hyperthyroidism and started oral propranolol and thiamazole. Subsequently, his tachycardia and tremor disappeared. On day 12 of the first course of BEP, his hCG level decreased to less than 50,000 mIU/ml. Also, his fT4 level returned to the normal range. Case 2 : A 29-year-old man presented with a left scrotal mass. He was diagnosed with non-seminoma testicular cancer (embryonal carcinoma and choriocarcinoma) with multiple lung, liver and lymph node metastases. On the admission day, his serum hCG and fT4 levels were high ; 3.23 million mIU/ml and 2.2 ng/dl, respectively. The TSH level was low at 0.011 mIU/ml. On day 3 of the first course of BEP, his hCG and fT4 levels increased to 4.5 million mIU/ml and 3.0 ng/dl, respectively. He complained of tachycardia, tremor and hyperhydrosis. He was started on propranolol and potassium iodide. After the treatment, histachycardia, tremor and hyperhidrosisdis appeared. HisfT4 level normalized on day 17 of the first course of BEP. The TSH-like activity of hCG is considered to be responsible for paraneoplastic hyperthyroidism among germ cell cancer patients with high hCG levels. To our knowledge, thisisthe first report of such a case in Japan. However, thisphenomenon isnot rare among patients with extremely high hCG levels. Therefore, we should be careful of these patients.
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Chihara
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nitta
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kimura
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Shuya
authors.initials: S
authors.lastname: Kandori
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawahara
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Natsui
authors.initials: N
authors.lastname: Waku
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kojima
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Akira
authors.initials: A
authors.lastname: Joraku
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: The Division of Endocrinology and Metabolism, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: The Division of Endocrinology and Metabolism, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: The Department of Urology, The Department of Internal Medicine, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin