Thyrotoxic crisis associated with gestational trophoblastic disease
Carlos Eduardo David de Almeida1, Erick Freitas Curi, Carlos Roberto David de Almeida
1Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio Moraes, Brazil. cedalmeida@terra.com.br
Revista Brasileira De Anestesiologia
|September 17, 2011
Summary
High levels of human chorionic gonadotropin (HCG) in gestational trophoblastic disease can cause hyperthyroidism. This case highlights how iodinated contrast can trigger a thyrotoxic crisis in such patients.
Area of Science:
- Endocrinology
- Obstetrics
- Anesthesiology
Background:
- Human chorionic gonadotropin (HCG) shares structural and receptor similarities with thyrotrophic hormone (TSH).
- Elevated HCG levels in gestational trophoblastic diseases can lead to secondary hyperthyroidism.
Observation:
- A patient with a complete hydatidiform mole presented with severe vaginal bleeding post-iodinated contrast tomography.
- During anesthetic induction, the patient exhibited symptoms consistent with a thyrotoxic crisis.
Findings:
- Iodinated contrast administration precipitated a thyrotoxic crisis in a patient with a hydatidiform mole.
- This event underscores the potential for contrast media to exacerbate underlying thyroid dysfunction.
Implications:
- Early diagnosis of gestational trophoblastic disease reduces severe presentations.
- Anesthesiologists must remain vigilant for the risk of thyrotoxic crisis in these patients, especially after contrast administration.
Related Concept Videos
01:25Hyperthyroidism I: Introduction
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
01:27Hyperthyroidism II: Pathophysiology
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...
01:24Graves Disease II: Pathophysiology
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
01:28Graves' Disease I: Introduction
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence in...
01:20Synthesis and Regulation of Thyroid Hormones
Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
01:27Goiter
Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...