Hyperthyroidism and Gestational Trophoblastic Disease: A Case Report

KJ Lingeswary; Jean Mun Cheah; Fei Bing Yong; Jen Hoong Oon; Aniqah Shamimi; Sharifah Noor Adrilla binti Long Mohd Noor Affendi; Gayathri Devi A/P Krishnan; Shazatul Reza Binti Mohd Redzuan; Subashini Rajoo

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Hyperthyroidism and Gestational Trophoblastic Disease: A Case Report

Author: K.J. Lingeswary ¹ ; Jean Mun Cheah ¹ ; Fei Bing Yong ¹ ; Jen Hoong Oon ¹ ; Aniqah Shamimi ¹ ; Sharifah Noor Adrilla binti Long Mohd Noor Affendi ¹ ; Gayathri Devi A/P Krishnan ¹ ; Shazatul Reza Binti Mohd Redzuan ¹ ; Subashini Rajoo ¹
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1. Endocrine Unit, Hospital Kuala Lumpur
Publication Type:Journal Article
MeSH: Gestational Trophoblastic Disease; Hyperthyroidism
From: Journal of the ASEAN Federation of Endocrine Societies 2026;41(S1):118-119
CountryPhilippines
Language:English
Abstract: Introduction:Gestational trophoblastic disease (GTD) is an uncommon but important cause of secondary hyperthyroidism, termed trophoblastic hyperthyroidism, resulting from the structural similarity between human chorionic gonadotropin (hCG) and thyroid-stimulating hormone (TSH). Excessively elevated hCG levels can stimulate the TSH receptor, leading to increased thyroid hormone production and clinically significant thyrotoxicosis. Early recognition is essential as uncontrolled hyperthyroidism may lead to serious perioperative complications.
Case:We report a 50-year-old female who presented with persistent vaginal bleeding following a prior uterine evacuation. Clinical examination and ultrasonography revealed a uterine mass corresponding to approximately 14 weeks’ gestation. Serum β-hCG was markedly elevated at >1,000,000 IU/L. Histopathological evaluation confirmed choriocarcinoma. Thyroid function tests demonstrated severe biochemical hyperthyroidism, with suppressed TSH and elevated free thyroxine levels. Notably, the patient did not exhibit classic symptoms or signs of hyperthyroidism such as palpitations, tremor, goiter, or thyroid eye signs. She was started on beta-blockers and carbimazole for initial control. Given the underlying pathology, early definitive surgical management was planned with multidisciplinary input, and she subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy successfully. Hyperthyroidism in GTD is well described, but patients may remain clinically asymptomatic despite significant biochemical derangement, as seen in this case. Markedly elevated β-hCG can mimic primary thyroid disease and may lead to misinterpretation if the underlying cause is not recognized. While antithyroid drugs such as carbimazole are commonly initiated, they may have limited effect in this setting, as the hyperthyroidism is driven by hCG rather than intrinsic thyroid overactivity. Beta-blockers play an important role in controlling symptoms and reducing peripheral conversion of T4–T3. Early definitive treatment of the underlying trophoblastic disease remains the key to resolution.
Conclusion:Trophoblastic hyperthyroidism is a reversible condition secondary to the underlying disease process. Treatment of the trophoblastic tumor results in resolution of the thyrotoxic state. Early recognition and appropriate preoperative optimization are essential to ensure safe patient outcomes.
Full text:2026080509454198262EP_A177.pdf