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Abstract
Severe hyperthyroidism can cause cardiac complications, such as severe rhythm disturbances, heart failure and angina. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from benign hydatidiform mole to malignant form. Clinical hyperthyroidism may occur in GTD, as human chorionic gonadotropin (hCG) secreted by molar tissue is structurally similar to thyroid-stimulating hormone. Cardiothyreosis in this context is exceptional. We report the case of a nulligravida 42-year-old woman without thyroid or cardiac history who presented to the emergency department for dyspnoea. Examinations revealed an acute pulmonary oedema and sinus tachycardia. Serum hCG concentration was abnormally high (762 878 UI/l, N < 5). CT scan showed a voluminous uterine mass and eliminated pulmonary embolism. Cardiac output was increased in echocardiography. Complementary blood tests showed a peripheral hyperthyroidism. GTD was evoked in the context of uterine mass and high hCG concentration, which was responsible for inducing clinical hyperthyroidism and cardiothyreosis. A total hysterectomy was performed and histopathological examinations concluded to a non-invasive complete hydatidiform mole (begnin form). hCG fell to normal within 12 weeks, cardiac and thyroid functions normalized after mole evacuation.
Chinese abstract
严重的甲状腺功能亢进可以导致心脏并发症，例如严重的心率失常，心衰和心绞痛。妊娠滋养细胞疾病（GTD）是一种罕见的妊娠相关疾病，包括良性和恶性葡萄胎。在临床上GTD可能会诱发甲亢，因为人绒毛膜促性腺素（HCG）在结构上类似于促甲状腺素。甲状腺心脏病在这种情况下是个例外。我们报道了一例42岁的女性病人，未孕，无甲状腺和心脏病史，表现为急性呼吸困难。检查提示急性肺水肿和窦性心动过速。血清HCG浓度异常升高(762 878 UI/l, N＜5)。CT扫描显示子宫体积增大和肺水肿。超声心动图显示心输出量增加。血液化验显示甲状腺功能亢进。子宫体积异常增大和高浓度HCG可以诱发GTD，并随后诱发甲亢和甲状腺心脏病。子宫全切后组织病理学检查提示是一个完全性非侵入性葡萄胎（良性）。HCG水平在12周内降至正常，随后心脏和甲状腺功能也恢复正常。
Declaration of interest
The authors report no declaration of interest.