Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study

ABSTRACT BACKGROUND: Gestational trophoblastic diseases (GTDs) are treatable rare tumors with wide distribution. The estimated incidence of GTDs varies dramatically between different regions globally. In early pregnancy, there may be high human chorionic gonadotropin (HCG) concentrations, normal or slightly increased free T4 (fT4) and subnormal thyroid-stimulating hormone (TSH), causing hyperthyroidism ranging from subclinical to severe. Beta-HCG causes thyrotoxicosis through thyroid stimulation in patients with trophoblastic tumors. OBJECTIVE: To assess thyroid function among patients diagnosed with complete or partial hydatidiform mole, within the GTD spectrum. DESIGN AND SETTING: Cross-sectional study based on patients’ medical records at Van University Hospital, Van, Turkey. METHODS: 50 patients monitored due to diagnoses of hydatidiform mole were included and were examined regarding thyroid function. Thyroid gland size and volume were measured using thyroid ultrasonography. Beta-HCG, TSH, fT4, free T3 (fT3), total T4 (TT4), total T3 (TT3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and thyroglobulin levels were measured. RESULTS: Among these patients, 15 (30%) were diagnosed with complete hydatidiform mole and 35 (70%) with partial hydatidiform mole, according to pathology results. Those with complete hydatidiform mole were older (P = 0.003), with higher number of pregnancies (P = 0.032), lower TSH level (P = 0.011) and higher fT4 and TT4 levels (P = 0.04; P = 0.028), compared with partial hydatidiform mole patients. CONCLUSION: In hydatidiform mole patients, thyroid disease severity increases with age, parity, beta-HCG level and mole size. However, prospective multicenter studies on this topic are needed, with larger numbers of patients and closer monitoring.

摘要
背景：妊娠滋养细胞疾病（Gestational trophoblastic diseases, GTDs）是一类分布广泛且可治愈的罕见肿瘤。全球不同地区的GTDs预估发病率差异悬殊。早孕阶段，患者可出现人绒毛膜促性腺激素（human chorionic gonadotropin, HCG）水平升高，游离甲状腺素（free T4, fT4）水平正常或轻度升高，促甲状腺激素（thyroid-stimulating hormone, TSH）水平低于正常，进而引发从亚临床到重度的甲状腺功能亢进症。滋养细胞肿瘤患者体内的β-HCG可通过刺激甲状腺诱发甲状腺毒症。
研究目的：旨在评估妊娠滋养细胞疾病谱系中确诊为完全性葡萄胎或部分性葡萄胎患者的甲状腺功能状态。
研究设计与研究地点：本研究为横断面研究，数据来源于土耳其凡城凡城大学医院的患者病历档案。
研究方法：纳入50例因确诊葡萄胎而接受随访的患者，对其甲状腺功能进行评估检测。采用甲状腺超声检查测量甲状腺大小与体积；检测指标包括β-HCG、TSH、fT4、游离三碘甲状腺原氨酸（free T3, fT3）、总甲状腺素（total T4, TT4）、总三碘甲状腺原氨酸（total T3, TT3）、抗甲状腺过氧化物酶抗体（anti-thyroid peroxidase, anti-TPO）、抗甲状腺球蛋白抗体（anti-thyroglobulin, anti-TG）及甲状腺球蛋白水平。
研究结果：经病理结果确认，本研究纳入的患者中15例（30%）确诊为完全性葡萄胎，35例（70%）确诊为部分性葡萄胎。与部分性葡萄胎患者相比，完全性葡萄胎患者年龄更大（P=0.003）、妊娠次数更多（P=0.032）、TSH水平更低（P=0.011），且fT4与TT4水平更高（P=0.04；P=0.028）。
研究结论：葡萄胎患者的甲状腺疾病严重程度随年龄、产次、β-HCG水平及葡萄胎体积的增加而加重。但未来仍需开展更大样本量、更密切随访的多中心前瞻性研究，以进一步验证相关结论。