Mola hidatiforme completa invasiva: una causa poco común de hipertiroidismo / Invasive complete hydatidiform mole: a rare cause of hyperthyroidism

Hydatidiform mole (HM) is a form of gestational trophoblastic disease, which can be classified as complete or partial and is characterized by high levels of human chorionic gonadotropin (HCG). Hyperthyroidism results from the effect of β-hCG on TSH receptors. Clinical case: A 53-year-old multiparous woman, with no relevant history, was admitted to the Gynaecology Emergency Department with a clinic presentation of hypogastralgia and hyperemesis gravidarum with 1 month of evolution and symptoms of hyperthyroidism. The investigation showed a distended uterus with echogenic material with a thickness of 81 mm at filled by uterine cavity. β-hCG> 10000mIU / mL. She was admitted for suction curettage, and the resulting sample was compatible with HM. The additional analytical study showed primary hyperthyroidism and negative thyroid autoimmunity. Thyroid ultrasound was unaltered. The patient started therapy with metibasol and propanolol, showing clinical and analytical improvement. She also underwent, total abdominal hysterectomy and bilateral annexectomy with general anaesthesia, without complications. Chest x-ray without changes. Through histological analysis it was determined that the diagnosis was that of an invasive complete HM. Sixteen weeks after surgery, she presented β-hCG <2mIU / mL and normal thyroid function. The patient is still being monitored in the Gynaecology outpatient consultation. Thyroid function should be included in the laboratory analysis of HM. Removing the source of β-hCG allows the resolution of hyperthyroidism. However, due to the risk of thyroid storm, it is crucial to control the thyroid function before performing the surgical procedure. Given the possibility of persistence of trophoblastic tissue, it is essential to maintain regular follow-up with β-hCG assays. (AU)

Síndrome de Cushing ATCH-dependiente durante el embarazo tratado con metirapona / ACTH-dependent Cushing’s syndrome during pregnancy treated with metyrapone

Cushing’s syndrome (CS) rarely occurs during pregnancy due to the influence of the hypercortisolism on the reproductive axis, with only a few cases described. We present a case of a 32 years-old woman diagnosed with ACTH-dependent CS and no clear pituitary lesion on the MRI. She was on ketoconazole when she discovered she was 8-weeks pregnant. Ketoconazole was stopped and a conservative management was decided. At 26 weeks of gestation, the patient developed gestational diabetes and treatment with metyrapone was started. Metyrapone was well tolerated and the pregnancy proceeded without further complications. She gave birth to a male infant, via cesarean section, at 36 weeks, with no apparent teratogenic effects of metyrapone. Many authors consider surgery as the first-choice treatment in pregnant women with CS but there is no consensus on the best management in such patients. Pharmacological treatment with metyrapone may be a safe and effective alternative. (AU)

Treatment of differentiated thyroid carcinoma: a survey.

INTRODUCTION: In January 2005, during the annual meeting of the Portuguese Society of Endocrinology, Diabetes and Metabolism, a questionnaire on the treatment and follow-up of differentiated thyroid carcinoma (DTC) was given to attendants. The aim of this study was to present the survey's results. METHODS: The questionnaire addressed the following issues: the surgical treatment of the gland and cervical lymph nodes, whole body scan and ablation with (131)I, suppression with levothyroxine, and treatment of recurrence and metastases. Fifty-four completed questionnaires were obtained (79% from clinical endocrinologists). RESULTS: When DTC is diagnosed, 67% of respondents reported that total thyroidectomy is always performed. When the diagnosis is made postsurgically, completion of thyroidectomy is recommended by 70% of respondents for papillary carcinoma, by 67% for papillary microcarcinoma and by 44% for minimally invasive follicular carcinoma. Most respondents recommend lymph node dissection if the nodes are involved; 61% systematically perform whole body scan with (131)I after surgery. Twenty-eight percent routinely perform ablation of the thyroid, and 59% request adjuvant radioiodine ablation of the thyroid bed if there is (131)I uptake, if thyroglobulin is increased, or if risk factors are present. The most commonly used ablation dose is 100 mCi. Consensus on the degree of TSH suppression is lacking. Twenty-two percent of the respondents recommend surgery as the first therapeutic option in recurrence and metastases, while 57% prefer (131)I for the treatment of local recurrence. When thyroglobulin levels remain high and the results of (131)I scanning are negative, 50% choose computed tomography scan for the diagnosis of disease recurrence. CONCLUSIONS: The wide variability of responses in this survey and the significant percentage (11 to 41%) of non-responders demonstrates the lack of uniformity in the treatment protocols for DCT in Portugal. According to the published guidelines and the responses to a similar survey performed in Spain, the widest differences are mainly found in lymph node dissection and the treatment of disease recurrence.