Human Chorionic Gonadotropin and Thyroid Function in Patients with Hydatidiform Mole

A case of a 56-year-old woman with a mole pregnancy and a human chorionic gonadotropin (HCG)-induced thyreotoxicosis is presented. A proper diagnosis was only made after a period of patient and doctor's delay. After performing a hysterectomy, the HCG quickly normalized. Thyroid function normalized with thiamazol treatment. It is well known that older women have a higher risk to develop gestational trophoblastic disease (GTD). Furthermore, the chance of persistent trophoblastic disease is increased in this population. The literature on risk factors for developing persistent GTD and the possibilities for treatment in older patients is reviewed.

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Thyroid Function in Gestational Trophoblastic Tumors

Tumori Journal ◽

10.1177/030089168607200216 ◽

1986 ◽

Vol 72 (2) ◽

pp. 205-209

Author(s):

Franca Vergadoro ◽

Laura Tabacchi ◽

Pietro Barbacini ◽

Laura Vassena ◽

Flavia Zanaboni ◽

...

Keyword(s):

Thyroid Function ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Hydatidiform Mole ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Free T4 ◽

Free T3 ◽

Normal Limits ◽

Trophoblastic Tumors

Thyroid function was assessed in a total of 15 cases, 7 of whom had choriocarcinoma and 8 hydatidiform mole, by measuring free T3, free T4, thyroxin-binding globulin (TBG), basal thyroid-stimulating hormone (TSH) and after the thyrotropin-releasing hormone test (ΔTSH). Free T3, free T4 and TBG were investigated in the same number of healthy women within the first three months of pregnancy. Only 13.4% of the cases presented elevated levels of free T3 and T4 and TBG; TSH and ΔTSH were within normal limits. Both thyroid hormones and TBG returned to within normal limits when β-human chorionic gonadotropin became undetectable. One patient was found to be hypothyroid. Comparison with the control group showed no significant differences except in TBG levels, which were higher in controls. A significant, direct correlation was found between levels of free T3 and T4 and TBG and the pattern of human chorionic gonadotropin.

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IMMUNOHISTOCHEMICAL LOCALIZATION OF HUMAN CHORIONIC GONADOTROPIN

Journal of Experimental Medicine ◽

10.1084/jem.115.2.289 ◽

1962 ◽

Vol 115 (2) ◽

pp. 289-294 ◽

Cited By ~ 149

Author(s):

A. R. Midgley ◽

G. B. Pierce

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Hydatidiform Mole ◽

Immunohistochemical Localization ◽

Formalin Fixation ◽

Cell Of Origin ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Immunohistochemical Techniques ◽

Formalin Fixed

Through the use of immunohistochemical techniques, human chorionic gonadotropin has been localized to syncytiotrophoblastic cells of immature placenta, hydatidiform mole, chorioadenoma destruens, and choriocarcinoma. No gonadotropin has been detected in cytotrophoblast. Evidence is discussed which suggests that syncytiotrophoblast is the cell of origin of human chorionic gonadotropin. The observation that formalin fixation did not alter the ability of human chorionic gonadotropin to react with its specific antibody permitted the study of formalin-fixed paraffin-embedded tissues stored in the tissue collection. In addition, the excellence of histologic preparations following formalin fixation facilitated cytologic identification.

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Ovarian and Adrenal Androgens and Their Link to High Human Chorionic Gonadotropin Levels: A Prospective Controlled Study

International Journal of Endocrinology ◽

10.1155/2014/191247 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

René Rodríguez-Gutiérrez ◽

Jesús Zacarías Villarreal-Pérez ◽

Felipe Arturo Morales-Martinez ◽

René Rodríguez-Guajardo ◽

Gloria González-Saldivar ◽

...

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Strong Correlation ◽

Hydatidiform Mole ◽

Free Testosterone ◽

Dehydroepiandrosterone Sulfate ◽

Controlled Study ◽

Control Group ◽

The Difference ◽

Prospective Longitudinal

Background. Although the association between human chorionic gonadotropin (hCG) and hyperandrogenism was identified more than 40 years ago, relevant questions remain unanswered.Design and Methods. We conducted a prospective, longitudinal, and controlled study in 23 women with a diagnosis of a complete hydatidiform mole (HM).Results. All participants completed the study. Before HM evacuation mean hCG was markedly higher in the cases than in the control group (P≤0.001). Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P=0.0001and 0.001), respectively. There was a strong correlation between hCG and free T/total T/DHEA-S concentrations (r=0.78;P≤0.001,r=0.74; P≤0.001, andr=0.71; P≤0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P=0.001) and free T and DHEA-S declined significantly (P=0.0002and 0.009).Conclusion. Before uterus evacuation, hCG, free T, and DHEA-S levels were significantly higher when compared with controls finding a strong correlation between hCG and free T/DHEA-S levels. Forty-eight hours after HM treatment hCG levels declined and the difference was lost. A novel finding of our study is that in cases, besides free T, DHEA-S was also found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction.

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Clinical Utility of Hyperglycosylated hCG in Serum Taken before Hydatidiform Mole Evacuation to Predict Persistent Trophoblastic Disease

The International Journal of Biological Markers ◽

10.1177/172460080602100107 ◽

2006 ◽

Vol 21 (1) ◽

pp. 45-49 ◽

Cited By ~ 3

Author(s):

H. Ngo Duc ◽

N.E. van Trommel ◽

F.C.G.J. Sweep ◽

L.F.A.G. Massuger ◽

C.M.G. Thomas

Keyword(s):

Diagnostic Accuracy ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Hydatidiform Mole ◽

Subsequent Development ◽

Serum Samples ◽

Roc Curve Analysis ◽

Trophoblastic Disease ◽

Central Registry ◽

Hydatidiform Moles

Objective Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG β-subunit (free hCGβ), “total” hCG (hCG+hCGβ) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGβ/hCG+hCGβ, hCGβ/ITA and hCG+hCGβ/ITA could predict the later development of PTD. Design A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD. Methods Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGβ, total hCG, and ITA. From these analytes we also calculated the ratios hCGβ/hCG+hCGβ, hCGβ/ITA, and hCG+hCGβ/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4–0.6). Results The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGβ (0.610) and hCG+hCGβ (0.622). Conclusions ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.

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An Invasive Molar Pregnancy: A Case Report With Associated Imaging

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479320936229 ◽

2020 ◽

Vol 36 (5) ◽

pp. 498-500

Author(s):

Elliot M. Levine ◽

Carlos M. Fernandez ◽

Angela McElwee

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Hydatidiform Mole ◽

Three Dimensional ◽

Uterine Wall ◽

Transvaginal Sonography ◽

Molar Pregnancy ◽

Two Dimensional ◽

Clinical Imaging ◽

Clinical Advantage

Human chorionic gonadotropin is generally used as a biomarker to identify invasive molar pregnancy. The extent of the disease (e.g., its staging) has not, however, relied on its sonographic description. A case is presented that can illustrate some diagnostically useful sonographic features of three-dimensional transvaginal sonography for this condition. The clinical imaging of this case initially suggested it to be a benign hydatidiform mole but ultimately was diagnosed as an invasive molar pregnancy, with human chorionic gonadotropin monitoring. Clinical imaging was used to help manage this patient, with the demonstration of trophoblastic invasion of the uterine wall. Although two-dimensional sonography is commonly used to diagnose molar pregnancy, three-dimensional sonography may offer a clinical advantage for the management of invasive molar pregnancy, which can occur in 15% of benign hydatidiform molar pregnancies.

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Analysis of 309 Cases after Hydatidiform Mole: Different Follow-Up Program According to Biologic Behavior

Tumori Journal ◽

10.1177/030089168807400116 ◽

1988 ◽

Vol 74 (1) ◽

pp. 93-96 ◽

Cited By ~ 6

Author(s):

Giorgio Bolis ◽

Carlo Belloni ◽

Cristina Bonazzi ◽

Giorgia Mangili ◽

Mauro Presti ◽

...

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Selection Criteria ◽

Hydatidiform Mole ◽

Spontaneous Remission ◽

Obstetrics And Gynecology ◽

Surveillance Program ◽

Beta Human Chorionic Gonadotropin ◽

Trophoblastic Tumors

Between 1976 and 1985, at the Obstetrics and Gynecology Department of Milan University, a total of 309 cases of hydatidiform mole, 223 complete moles and 86 partial moles, were monitored with the assay of beta-human chorionic gonadotropin, following a postmolar biochemical surveillance program. Spontaneous remission of the disease occurred in 287 (92.9%) patients. Marker levels were undetectable in 80.4 % of cases within 60 days after evacuation of the mole and in 19.6% between 61 and 140 days. There were 22 (7.1%) patients diagnosed as having gestational trophoblastic tumors (GTT) and treated with chemotherapy: 20 were complete moles and 2 partial moles. Considering these data, the authors suggest different follow-up times for partial and complete moles and confirm the necessity of selection criteria in a diagnosis of GTT.

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