Arch Gynecol Obstet (2009) 279:411–413 DOI 10.1007/s00404-008-0734-0
C A S E RE P O RT
Complete hydatidiform mole in a perimenopausal woman with a subsequent severe thyriotoxicosis Lena Struthmann · Margit Günthner-Biller · Florian Bergauer · Klaus Friese · Ioannis Mylonas
Received: 7 January 2008 / Accepted: 8 July 2008 / Published online: 19 July 2008 © Springer-Verlag 2008
Abstract Introduction Gestational trophoblastic disease is one form of abnormal pregnancy, with a median maternal age of 27–28 years. One complication of trophoblastic disease is the development of a secondary hyperthyroidism, which resolves rapidly after evacuation of the hydatidiform mole. Case report We report a case of a 53-year-old woman presenting with a complete hydatidiform mole and who developed a severe thyrotoxicosis after suction evacuation of the hydatidiform mole. Conclusion A severe thyriotoxicosis can occur even after surgical evacuation of the mole. Therefore, evaluation of the thyroid function prior to operation, especially with a high quantitative hCG, should be performed to avoid severe complications.
reproductive life. Although the risk for the development of a complete mole at a postmenopausal age is greater than that of a partial mole [2], there are just a few cases reported [3–8]. One complication of trophoblastic disease is the development of secondary hyperthyroidism [9–11]. This hyperthyroidism resolves rapidly after evacuation of the hydatidiform mole [9, 12, 13]. The severity of trophoblastic disease-associated hyperthyroidism can vary from clinically asymptomatic elevations of thyroid hormones to lifethreatening thyrotoxicosis. We report a case of a perimenopausal woman presenting with a complete hydatidiform mole and who developed a severe thyrotoxicosis after suction evacuation of the hydatidiform mole.
Keywords Complete hydatidiform mole · hCG · Perimenopausal · Hyperthyroidism · Thyrotoxicosis
Case report
Introduction Gestational trophoblastic disease is one form of abnormal pregnancy. There are a number of diVerent manifestations such as complete and partial hydatidiform mole, invasive mole, placental site tumor and choriocarcinoma [1]. Although the median maternal age is 27–28 years, the risk for gestational trophoblastic disease rises at the extremes of
L. Struthmann · M. Günthner-Biller · F. Bergauer · K. Friese · I. Mylonas (&) First Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistrasse 11, 80337 Munich, Germany e-mail:
[email protected]
A 53-year-old woman eight gravida with six spontaneous deliveries presented for vaginal bleeding and pain in the hypogastrium in the emergency ward of our hospital. She had been having normal menstrual cycles up to 3 months prior to presentation. She reported tenderness of the left breast for the last 2 months, as well as vomiting and nausea for the preceding week. Her past medical history was unremarkable. Physical examination revealed a tumour in the hypogastrium consistent with a pregnant uterus reaching up to 5 cm over the navel. Vaginal and recto-vaginal examination was without pathological Wndings. Vaginal sonography showed an enlarged uterus Wlled with an inhomogeneous mass with an aspect of a snow Xurry (Fig. 1a, b). The serological results showed a quantitative serum human chorionic gonadotropin (hCG) of 1,400,000 IU/l. Liver sonography was
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Fig. 1 Primarily sonographic Wndings of an enlarged uterus Wlled with an inhomogeneous mass with an aspect of a snow Xurry (a vertical level; b sagittal level)
without Wnding (Fig. 2). These Wndings were suspected for a hydatidiform mole with a diVerential diagnosis of a chorioncarcinoma. A suction curettage under sonographic control was performed without any complications, delivering 1,200 ml of a grapelike mass with the macroscopic aspect of a hydatidiform mole. The day after the operation the patient developed shortness of breath, shivering, fever with 39.4°C degrees and a tachycardia of 170 bpm. The laboratory
Fig. 2 Sonographic Wndings of the liver without signs of metastasis of the gestational trophoblastic disease
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Arch Gynecol Obstet (2009) 279:411–413
results demonstrated a low TSH with 0.02 U/ml (physiological range 0.3–4 U/ml), high D-dimer 3.32 g/ml (physiological range
