Abstract
Context Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.
Highlights
Molecular mimicry between human chorionic gonadotrophin and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. is is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH)
Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation
Twin gestation with HM is even rarer with an estimated incidence of 1 per 20,000 to 100,000 pregnancies [4] and is associated with severe maternal complications and fetal complications [1, 4,5,6]
Summary
A 24-year-old G4 P3 Caucasian female with a history of hypertension and type II diabetes mellitus presented to the emergency room with vaginal bleeding at 13 weeks of gestation. On presentation, she reported dizziness, diaphoresis, tremors, anxiety, palpitations, nausea, and leg swelling. After extensive discussion regarding risk of developing complications associated with molar pregnancy [1], she preferred to proceed with her current pregnancy until viability of fetus As she was into her 2nd trimester of pregnancy, she was started on methimazole and the dose was titrated to achieve a goal free T4 in the upper range of normal (normal range 0.8–1.7 ng/dL) to prevent fetal hypothyroidism. She was Laboratory test Anti-thyroid peroxidase Ab T3 yroglobulin antibody TSH receptor antibody Urine protein creatinine ratio Total protein/day, urine Platelet count Hemoglobin Hematocrit WBC Glucose Creatinine Sodium Potassium Alkaline phosphatase Alanine transaminase Aspartate transaminase Total bilirubin LDH
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