Choriocarcinoma as a cause of hyperthyroidism

<span class="paragraphSection">Our patient is a 31-year-old lady who delivered her third child 3 months prior to the current admission. The delivery was uneventful but she continued to have per vaginal spotting occasionally. She presented with cough and breathlessness for 2 months associated with significant weight and appetite loss. On examination she was pale and tachycardic. She had fine tremor but no goiter or Grave’s opthalmopathy. Breath sounds were reduced bilaterally. Endocrine team was consulted as her thyroid function test showed freeT4 of 50 pmol/l with suppressed thyroid stimulating hormone (TSH) of <0.01 mIU/L. There were multiple canon ball lesions bilaterally in her chest x-ray (<a href="#hcw201-F1" class="reflinks">Figure 1</a>). Beta human chorionic gonadotrophin (HCG) was markedly elevated (>200 000 mIU/ml). Trans-abdominal ultrasound revealed uterine mass with snowstorm appearance. 250 cc vesicle-like tissue was removed during evacuation. Histopathology examination of endometrial tissue was consistent with choriocarcinoma. Hyperthyroidism was treated with Lugol’s iodine, Carbimazole and propanolol. Chemotherapy (Methotrexate, Actinomycin and Etoposide) was initiated post surgery. Her thyroid function test improved dramatically with reduction of Beta HCG. Figure 1Chest X-ray showing multiple canon ball lesions.</span>
Source: QJM - Category: Internal Medicine Source Type: research