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Thromboblastic hyperthyroidism: sensitive monoclonal TSH assay demonstrates suppressed immunoreactive TSH.
B Abuaisha1, E Barrett, J O'Hare
1Department of Medicine, Limerick Regional Hospital, Dooradoyle.
Irish Journal of Medical Science
|March 1, 1991
Summary
This study details a case of hyperthyroidism caused by a hydatidiform mole, likely due to human chorionic gonadotrophin (hCG). Modern TSH assays accurately measure thyroid function despite high hCG levels, unlike older methods.
Area of Science:
- Endocrinology
- Gynecologic Oncology
- Reproductive Medicine
Background:
- Hydatidiform mole, a gestational trophoblastic neoplasm, can cause hyperthyroidism.
- Human chorionic gonadotrophin (hCG) produced by the mole is implicated in thyroid dysfunction.
- hCG interference with thyroid-stimulating hormone (TSH) assays can lead to misdiagnosis.
Observation:
- A patient presented with clinical hyperthyroidism secondary to a hydatidiform mole.
- Circulating hCG levels exceeded 10^6 u/L.
- Thyroid function was assessed using a modern chemiluminescent immunometric TSH assay.
Findings:
- The chemiluminescent immunometric TSH assay did not show falsely elevated TSH levels.
- This assay demonstrated accuracy despite extremely high hCG concentrations.
- Older TSH radioimmunoassays are known to cross-react with hCG.
Implications:
- Modern TSH assays are reliable for diagnosing thyroid dysfunction in patients with hydatidiform mole.
- Accurate TSH measurement is crucial for appropriate management of mole-associated hyperthyroidism.
- This highlights the importance of assay methodology in clinical endocrinology.