From Molar Pregnancy, Thyrotoxicosis, to Pulmonary Hypertension: A Case Report
DOI:
https://doi.org/10.25077/aoj.8.1.661-666.2024Keywords:
Molar pregnancy, Pulmonary hypertension, ThyrotoxicosisAbstract
Background: Molar pregnancy is a benign condition with the dominant symptom being dark brown to bright red bleeding from the vagina. This disease can induce hyperthyroidism and result in pulmonary hypertension. This case report describes a patient who had molar pregnancy with thyrotoxicosis and pulmonary hypertension.
Case: A 30-year-old woman presented with complaints of lower abdominal pain for the last month. The patient feels that her stomach has enlarged in the last 3 months. Other complaints include bleeding and observed bubbles from the birth canal, shortness of breath, and chest pain. The serum cobas β-hCG level of 7954.00 mIU/mL. On abdominal ultrasound examination, vesicles formed a honeycomb appearance, measuring 7.4 cm×5.3 cm. Hematologic laboratory tests revealed low TSH levels (<0.01 μIU/mL), T3 levels of 2.35 ng/ml, and FT4 levels of 2.62 ng/dL. The results of the echocardiography examination showed there is a high probability of pulmonary hypertension.
Conclusion: Molar pregnancy can exacerbate thyrotoxicosis through hCG activity. Smoking and breastfeeding also have similar effects. Consequently, increased thyroid hormone levels can worsen or cause pulmonary hypertension.
References
Sharma S, Sharma S, Gandrabur L, Amin B, Rehmani R, Singh A. Molar Pregnancy Complicated by Impending Thyroid Storm. Cureus. 2021;13(11):11-4.
Albright BB, Shorter JM, Mastroyannis SA, Ko EM, Schreiber CA, Sonalkar S. Gestational Trophoblastic Neoplasia after Human Chorionic Gonadotropin Normalization Following Molar Pregnancy: A Systematic Review and Meta-analysis. Obstet Gynecol. 2020;135(1):12-23.
Blick C, Schreyer K. Gestational Trophoblastic Disease-induced Thyroid Storm. Clin Pract Cases Emerg Med. 2019;3(4):409-12.
Mayo Clinic. Molar Pregnancy [Internet]. Mayo Clinic. 2022 [cited 2023 Jul 9]. Available from: https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175
Araruna LVM, Oliveira DC de, Pereira MC, Moura Neto A, Tambascia MA, Zantut-Wittmann DE. Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves’ Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients. Front Endocrinol. 2022;12:1-8.
Khan Z, Mlawa G, Bashir M, Abumedian M, Yousif S, Gupta A, et al. Resolution of Thyrotoxicosis-Associated Pulmonary Hypertension With Treatment of Thyrotoxicosis: A Case-Based Report and Literature Review. Cureus. 2022;14(1):8-13.
Rashidi F, Sate H, Faraji E, Tahsini Tekantapeh S. Thyrotoxicosis Presenting as Exertional Dyspnea and Pulmonary Hypertension: Case Report and Review of Literature. SAGE Open Med Case Reports. 2017;5:1-3.
Nwabuobi C, Arlier S, Schatz F, Guzeloglu-Kayisli O, Lockwood CJ, Kayisli UA. HCG: Biological Functions and Clinical Applications. Int J Mol Sci. 2017;18(10):1-15.
Pirahanchi Y, Toro F, Jiala I. Physiology, Thyroid Stimulating Hormone - StatPearls - NCBI Bookshelf [Internet]. StatPearls. 2023 [cited 2023 Jul 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499850/
Hoermann R, Pekker MJ, Midgley JEM, Dietrich JW. The Role of Supporting and Disruptive Mechanisms of FT3 Homeostasis in Regulating the Hypothalamic–Pituitary–Thyroid Axis. Ther Adv Endocrinol Metab. 2023;14:1–9.
Virmani S, Srinivas SB, Bhat R, Rao R, Kudva R. Transient Thyrotoxicosis in Molar Pregnancy. J Clin Diagnostic Res. 2017;11(7):QD01–2.
Zhang Y, Shi L, Zhang Q, Peng N, Chen L, Lian X, et al. The Association Between Cigarette Smoking and Serum Thyroid Stimulating Hormone, Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies Levels in Chinese Residents: A Cross-Sectional Study in 10 Cities. PLoS One. 2019;14(11):1–15.
Kim S jin, Kim MJ, Yoon SG, Myong JP, Yu HW, Chai YJ, et al. Impact of Smoking on Thyroid Gland: Dose-Related Effect of Urinary Cotinine Levels on Thyroid Function and Thyroid Autoimmunity. Sci Rep. 2019;9(1):1–6.
Oakes JM, Xu J, Morris TM, Fried ND, Pearson CS, Lobell TD, et al. Effects of Chronic Nicotine Inhalation on Systemic and Pulmonary Blood Pressure and Right Ventricular Remodeling in Mice. Hypertension. 2020;75(5):1305–14.
Osuna PM, Udovcic M, Sharma MD. Hyperthyroidism and the heart. Methodist Debakey Cardiovasc J. 2018;20(3):167–72.
Ren B, Zhu Y. A New Perspective on Thyroid Hormones: Crosstalk with Reproductive Hormones in Females. Int J Mol Sci. 2022;23(5):1–13.
Uvnas-Moberg K, Ekstrom-Bergstrom A, Buckley S, Massarotti C, Pajalic Z, Luegmair K, et al. Maternal Plasma Levels of Oxytocin During Breastfeeding-A Systematic Review. PLoS ONE. 2020;15(8):1–38.
Nikhil P S, SA P, Khushboo S S, RD Z, Alka S. Correlation of Prolactin Levels With Thyroid Hormone Levels in Thyroid Disorders, Infertility and Menstrual Disorders. Int J Clin Biomed Res. 2018;4(2):12–5.
Mostert E. An Approach to the Pregnant Patient with Pulmonary Hypertension. South African J Anaesth Analg. 2018;24(3):S18–20.
Pulmonary Hypertension Association. Types of Pulmonary Hypertension: The WHO Groups [Internet]. PHA. 2020 [cited 2023 Aug 5]. Available from: https://phassociation.org/types-pulmonary-hypertension-groups/
Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, et al. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Circulation. 2019;139(25):2892–909.
Yamamoto H, Monno S, Ohta-Ogo K, Ishibashi-Ueda H, Hashimoto T. Delayed Diagnosis of Dilated Thyrotoxic Cardiomyopathy with Coexistent Multifocal Atrial Tachycardia: A Case Report. BMC Cardiovasc Disord. 2021;21(1):1–10.
Bhattacharya PT, Ellison MB. Right Ventricular Hypertrophy [Internet]. StatPearls. 2022 [cited 2023 Jul 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499876/
Razvi S, Jabbar A, Pingitore A, Danzi S, Biondi B, Klein I, et al. Thyroid Hormones and Cardiovascular Function and Diseases. J Am Coll Cardiol. 2018;71(16):1782–6.
Vieira L, Araruna M, Camargo De Oliveira D, Nica M, Pereira C, Neto AM, et al. Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves’ Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients. Front Endocrinol. 2022;12(780397):2–4.
Downloads
Additional Files
Published
Issue
Section
License
Copyright (c) 2024 Rudi Saputra, Dieni Azra, Fidya Mayastri Aswad, Setyawan Nurtanio
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
Authors who publish with this journal agree to the following terms:
- Authors retain the copyright of published articles and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
License:
Andalas Obstetrics and Gynecology Journal (AOJ) is published under the terms of the Creative Commons Attribution 4.0 International License. This license permits anyone to copy and redistribute this material in any form or format, compose, modify, and make derivatives of this material for any purpose, including commercial purposes, as long as they credit the author for the original work.
