Invasive Mole Research Articles

Analysis of the Factors in the Low-Risk Invasive Mole Treatment by Methotrexate: A Retrospective Study

The aim of this study is to retrospectively analyze the therapeutic effects of low-risk invasive mole treatment by methotrexate and summarize the high-risk factors which affect the chemotherapy outcome. Collect the clinical data of low-risk invasive mole treatment by methotrexate and analyze the relationship of human chorionic gonadotropin levels and largest tumor sizes with chemotherapy cycle and toxicity in Zhuzhou Central Hospital from 2015 to 2020. In this study, 42 patients of low-risk invasive mole treatment by methotrexate were enrolled in Zhuzhou Central Hospital from 2015 to 2020. All patients are treated by single-agent methotrexate, the remission rates are 80.95 %, the resistance rates are 11.91 % and the relapse rates are 7.14 %. After change of chemotherapy regimen, the cure rates were 100 %. Age, antecedent pregnancy, International Federation of Gynecology and Obstetrics staging and World Health Organization scoring has no significant difference (p=0.785, p=0.412, p= 0.135 and p=0.135, respectively). However, during the pre-treatment, human chorionic gonadotropin levels and largest tumor sizes were significant factors in the study (p=0.017 and p<0.0001). In addition, serum human chorionic gonadotropin levels and largest tumor size were significant risk factors which show impact on the chemotherapy cycles (p=0.023 and p=0.001). In this study, 10 patients have grade 2, 3 patients have grade 3 and 3 patients have grade 4. After careful study, there was no change in chemotherapy plan or death due to chemotherapy toxicity. In this retrospective study, we explained the single-agent methotrexate for the treatment of lowrisk invasive mole, the remission and resistance, and the relapse and chemotherapy toxicity was correlated with serum human chorionic gonadotropin levels and largest tumor size.

Clinical Presentation, Management and Outcome of Gestational Trophoblastic Diseases Admitted in Chittagong Medical College Hospital

Background: Gestational Trophoblastic Disease (GTD) is a heterogeneous group of diseases that includes partial and complete hydatidiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumour. The study aimed to determine the clinical presentation management options and outcome of GTD in patients admitted in a tertiary hospital of Bangladesh.&#x0D; Materials and methods: This prospective observational study included 50 patients with GTD from the Obstetrics and Gynaecology Department of Chittagong Medical College Hospital, during the period of July 2013 to December 2013. The demographic profile, clinical presentation, management, outcome and complications were studied.&#x0D; Results: Mean age was 25.40 ± 8.34 years with most of the patients (46%) were in age group 20 - 29 years. 42% participants were primigravida. The commonest symptom after bleeding per-vaginum (94%) was amenorrhea (90%). Maximum cases (80%) were of complete hydatidiform mole. Rate of progression to invasive mole and choriocarcinoma were found 6% and 10% respectively. Suction evacuation and hysterectomy were the treatment option. One patient (2%) expired due to excessive bleeding.&#x0D; Conclusion: The majority of cases are cured by simple suction uterine curettage. Regular follow up is important to estimate the true incidence of this disease.&#x0D; JCMCTA 2021 ; 32 (2) : 128-131

GESTATIONAL TROPHOBLASTIC DISEASE

Gestational trophoblastic disease (GTD) is a group of tumors defined by abnormal trophoblastic proliferation. GTD is divided into hydatidiform moles (contain villi) and other trophoblastic neoplasms (lack villi).1 The malignant forms of the disease are also collectively known as gestational trophoblastic tumors or neoplasia (GTN).GTN includes the invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Southeast Asia and Japan have the highest reported incidence estimated to be two in 1000 pregnancies. In high-income countries, the incidence of a complete mole is approximately 1–3 per 1000 pregnancies, and the incidence of a partial mole is about 3 per 1000 pregnancies. Approximately 15–20% of patients will be treated for gestational trophoblastic neoplasia after the evacuation of complete hydatidiform mole. GTD develop from abnormal proliferation of trophoblastic tissue and form botryoid arranged vesicles. Risk factors include extremes of age, ethnicity, and a prior history of an HM, suggesting a genetic basis for its etiology. GTD causes a broad spectrum of different symptoms. The most frequent clinical symptom is abnormal vaginal bleeding. Other signs include uterine enlargement more significant than expected for gestational age, absent fetal heart tones, cystic ovary enlargement, hyperemesis gravidarum, and abnormally high level of β-hCG for gestational age. Ultrasound is the gold standard in non-invasive techniques, but histological examination is necessary to reach the final diagnosis. Different treatment modalities are available for gestational trophoblastic neoplasm depending on the type and stage; these include D&amp;C (dilation and curettage), chemotherapy, hysterectomy, or a combination of these.2 The prognostic score for GTN reported by FIGO is a score of 0–6 is the low-risk group and 7 is the high-risk group. All patients who have hydatidiform mole should be up for β-hCG surveillance and monitoring. Most relapses occur within the first year after completion of chemotherapy. A generally approved schedule of β-hCG surveillance indicates monitoring weekly for six weeks after chemotherapy followed by biweekly measurements until six months after chemotherapy. Afterward, a biannual measurement of β-hCG for five years is sufficient.1 Seeing this, the determination of the diagnosis of GTD becomes very important. With the proper diagnosis, the management of the patient will also improve.

A rare cause of postpartum vaginal bleeding

BackgroundInvasive mole is a trophoblastic disease (GTD) caused by trophoblast cells invading the myometrium during pregnancy. The GTD range also includes mole hydatidiform, choriocarcinoma, and placental site trophoblastic tumor (PSTT). Invasive moles are most common following molar pregnancies; however, they can even rarely occur after a full-term birth. Despite the fact that pathology is the only way to make a clear diagnosis, clinic and radiologic evaluation can be helpful. We wanted to highlight a rare incidence of invasive mole following a healthy full-term delivery in this case.Case presentationA 28-year-old female patient presented with intermittent prolonged severe vaginal bleeding for 2 weeks after a term healthy vaginal delivery. In workup, beta human chorionic gonadotropin levels (b-hCG) value was 7540 mIU/ml. After suspicion of gestational trophoblastic neoplasm (GTN), the patient was sent to ultrasonography (US) and magnetic resonance imaging (MRI). GTN was confirmed by radiological and clinical findings, and a conclusive diagnosis of an invasive mole was made histopathologically.ConclusionInvasive mole should be considered in the differential diagnosis in patients with postpartum bleeding and a persistently high b-hCG level after a healthy term delivery.

Overview on the updates in vesicular molar pregnancy

Gestational trophoblastic disease (GTD) is one of the rare human tumors that originates in placental tissue and can be cured even with extensive metastases. GTDs include a variety of interrelated tumors, including full and partial moles, invasive moles, choriocarcinomas, and placental trophoblast tumors, which have different tendencies to infiltrate and spread locally.

Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

Case Report: Rare Presentation of Invasive Mole Following Term Pregnancy after Assisted Reproduction

Invasive mole (IM) is one of the Gestational trophoblastic neoplasia lesions, characterized by local invasion of trophoblastic with rare distal spread. It could follow any type of pregnancy and commonly arising from a complete hydatidiform mole (CHM). Pathogenesis of hydatidiform mole due to an underlying oocyte defect. Embryos are examined for triploidy to exclude dispermic fertilization in assisted reproduction technology (ART). Besides, several potential mechanisms and risk factors had been described to explain gestational trophoblastic neoplasia (GTN) following ART.

Triplet Pregnancy with a Complete Hydatidiform Mole and Two Live Fetuses: A Case Report

Background: A complete hydatidiform mole (CHM) coexistent with a live fetus is rare; however, in a triplet pregnancy it is even rarer. In such cases, diagnosis is complex and often delayed, since unlike cases of a hydatidiform mole alone, the coexisting CHM often fails to be detected at ultrasound, while Β-hCG, a marker of the disease, is already elevated because of the multiple pregnancy. The risk of maternal complications and of progression to malignant gestational trophoblastic disease is significantly greater in cases of a complete mole. Case: The case reported here refers to a triplet pregnancy consisting of two viable fetuses and a CHM. Conclusion: Outcome was favorable for the two live fetuses; however, the hydatidiform mole progressed to an invasive mole, requiring chemotherapy. Remission was achieved successfully.

VP01.15: Success management of partial invasive hydatidiform mole in a patient desiring fertility: a case report

VP01.15: Success management of partial invasive hydatidiform mole in a patient desiring fertility: a case report

Gut Microbial Diversity in Female Patients With Invasive Mole and Choriocarcinoma and Its Differences Versus Healthy Controls

ObjectiveTo investigate variation in gut microbiome in female patients with invasive mole (IM) and choriocarcinoma (CC) and compare it with healthy controls.MethodsFecal microbiome of 12 female patients with IM, 9 female patients with CC, and 24 healthy females were analyzed based on 16s rDNA sequencing. Alpha (α) diversity was evaluated using Shannon diversity index and Pielou evenness index, while beta (β) diversity was assessed using principle coordinate analysis (PCoA) of unweighted Unifrac distances. The potential functional changes of microbiomes were predicted using Tax4Fun. The relative abundance of microbial taxa was compared using Welch’s t test. The role of varied gut microbiota was analyzed via receiver operating characteristic (ROC) curve.ResultsThe α diversity and β diversity were significantly different between IM patients and controls, but not between CC patients and controls. In addition, the abundance of cancer-related genes was significantly increased in IM and CC patients. Notably, a total of 19 families and 39 genera were found to have significant differences in bacterial abundance. ROC analysis indicated that Prevotella_7 may be a potential biomarker among IM, CC, and controls.ConclusionOur study demonstrated that the diversity and composition of gut microbiota among IM patients, CC patients, and healthy females were significantly different, which provides rationale for using gut microbiota as diagnostic markers and treatment targets, as well as for further study of gut microbiota in gestational trophoblastic neoplasia (GTN).

The current situation of health services for hydatidiform mole in Cambodia

Management of hydatidiform mole is important to reduce the mortality and morbidity of choriocarcinoma. This study aims to understand the existing health services for hydatidiform mole and to estimate the incidence of gestational trophoblastic disease (GTD) in Cambodia. A questionnaire was used to collect information on the existing health services for pregnancy and hydatidiform mole at health facilities from attendants of the 16th Annual Conference of the Cambodian Society of Gynecology and Obstetrics in 2017. The incidence of GTD in 2014-2017 was estimated using Health Information System data. A total of 126 attendants, who were from all provinces except three provinces, answered the questionnaire. The work places were national hospitals (n=29), provincial hospitals (n=42), district hospitals (n=20), health centers (n=6), and others (n=29). The answers of participants from the public sector suggested the following: Ultrasonography is available at all hospitals but not health centers; Human chorionic gonadotropin (hCG) measurement is only available at national hospitals; Treatment of hydatidiform mole is performed at national hospitals and provincial hospitals; and Treatment of gestational trophoblastic neoplasia (GTN) is provided at national hospitals. The incidence of hydatidiform mole and GTN at health facilities in the public sector in 2014-2017 was 0.95 per 1000 deliveries and 6.58 per 100 000 deliveries, respectively. The results suggest that provincial hospitals are important to detect suspected invasive mole and refer to national hospitals for diagnosis and treatment. Further studies on the management of GTD and development of the guidelines of GTD are needed.

A Five-Year Retrospective Study of Gestational Trophoblastic Disease at University of Maiduguri Teaching Hospital Maiduguri, Nigeria

Background: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. It is of clinical and epidemiological interest partly because of its good prognosis if detected and managed early. Objective: This study was to determine the prevalence, clinical presentation, management outcome and histologic types of GTDs at University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methodology: A five-year retrospective study of histologically confirmed cases of GTDs managed in UMTH was undertaken. Folders of patient treated for GTD during the study period served as source of data. Statistical analysis was done using Statistical Package for the Social Sciences. Results: There were a total of 47 (38 molar and 9 choriocarcinoma) cases of GTDs that were diagnosed and managed at UMTH. However, only 40[31(77.5%)] molar and [9(22.5%) choriocarcinoma] case files were retrieved. 55% of the GTDs were complete hydatidiform mole, 22.5% partial hydatidiform mole and 22.5% choriocarcinoma. There was no case of invasive mole or placental site trophoblastic tumour noted. There were 15,426 deliveries in UMTH during this period giving the incidence of GTDs as 3.0 per 1000 deliveries or 1 in 328deliveries. The mean (SD) age of the patients was 30.5 ± 5.6years. Only 3(7.5%) of the patients were below 20 years of age and those who were at least 40 years of age constituted 8(20%). Low parity constituted 62.5% of the patients while 12.5% and 2.5% were nullipara and primipara respectively. The mean gestational age (SD) at presentation was 16.5±6.2 weeks. The common clinical presentations were amenorrhoea (100.0%), abnormal vaginal bleeding (97.5%), lower abdominal pain (90%) and passage of grape-like vesicles (45.0%). Only 6(15.0%) complied with the follow-up protocol for one year, while 25(62.5%) of the patients did not observe the follow-up protocol. Anaemia was the commonest complication observed. Conclusion: Gestational trophoblastic disease is relatively common in our center with an incidence of 3.0 per 1000 deliveries and 1.48% of our gynaecological admissions. Adequate patient counseling and compliance to follow-up are recommend for good outcome. Keywords: Prevalence, gestational trophoblastic disease, Hydatidiform mole, Choriocarcinoma, Maiduguri.

Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993–2017

Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993-2017. Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993-2017according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993–2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I–III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 –2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy.

Human chorionic gonadotrophin assays to monitor GTD.

Hydatidiform mole (HM) occurs in 1:500-1000 pregnancies and are generally characterised as a benign proliferative disorder of chorionic villous trophoblast. HM belongs to the group of disorders, collectively known as gestational trophoblastic disease (GTD), which include invasive mole, choriocarcinoma, placental site trophoblastic tumour and epitheloid trophoblastic tumour. Patients with HM are at increased risk of developing these malignant forms and hence accurate diagnosis is very important for monitoring persistent diseases and informing correct patient management. In this review, we describe the current model for HM follow-up in the UK, with special emphasis on the in-house human chorionic gonadotrophin (hCG) radioimmunoassay (RIA) currently employed for monitoring women in our programme. We briefly discuss the structure, function and significance of hCG monitoring in GTD and the limitations and benefits of the current assays used for measuring oncology hCG. In particular, we describe the preliminary work evaluating a replacement antibody for the current gold-standard UK-RIA method.

Role of Hysterectomy in Gestational Trophoblastic Neoplasia.

Hysterectomy has a limited role in the management of gestational trophoblastic neoplasia because of the high effectiveness of chemotherapy and the young age of patients. In selected patients, it is believed to help in reducing the number of chemotherapy cycles, overcoming chemo-resistance, and treating acute haemorrhagic events. The present study aimed to evaluate the indications and outcomes of hysterectomy in patients with GTN at a tertiary care centre in India. Between 2012 and 2019, we identified all patients with GTN from the hospital database. Demographic, clinical, and follow-up details of patients who underwent hysterectomy were obtained from the electronic medical records. During the study period, 98 cases of GTN were treated at our centre of which 54% were low-risk and 46% were high-risk cases. Twenty-six patients (26%) underwent hysterectomy as part of their management for GTN. The patients belonging to the high-risk group had more hysterectomies (65%) with an odds ratio of 2.96. The common pathological diagnosis was choriocarcinoma in 44% and an invasive mole in 30% of patients. Bleeding, either intraperitoneal or vaginal, was the most common indication for hysterectomy (48%). The median number of chemotherapy cycles received was 5 in patients who had primary hysterectomy and 6 in patients who did not have hysterectomy. The majority of patients received EMACO (57.7%) chemotherapy. The mean duration of follow-up was 18months (range 1-67).After treatment, complete remission was achieved in 94 out of 98 (95.9%) and also in all patients (100%) who had undergone hysterectomy as adjuvant procedure. Three patients died during treatment (3.06%), all belonging to the high-risk group, and one patient had a recurrence (0.01%). In selected cases of GTN, hysterectomy may be an effective means to reduce or eliminate tumour bulk, to overcome chemoresistance and manage acute bleeding events.

English

BACKGROUND Gestational trophoblastic diseases have varying clinical presentations with certain diagnostic signs and symptoms. A strong correlation between gestational trophoblastic diseases (GTD) and a previous history of dilation &amp; evacuation (D &amp; E) has been documented in the limited available literature. We wanted to study the spectrum of gestational trophoblastic disease secondary to dilation &amp; evacuation. METHODS A two-year study including all the females who were admitted to MMIMSR Hospital in view of suspicion of gestational trophoblastic disease was conducted with all having a common history of dilatation and evacuation in the recent past. RESULTS Through the analysis we saw the spectrum of GTD including partial mole, complete mole, invasive mole and choriocarcinoma, as well as its complications in the form of arterio-venous malformation (AVM). CONCLUSIONS The two-year experience suggests that dilatation and curettage may predispose a female of reproductive age group to develop gestational trophoblastic disease in the future. Hence, a high index of suspicion is necessary for timely diagnosis and intervention. The study further helped us understand the wide spectrum of the disease and its associated complications. KEY WORDS Abortion, AVM, Dilatation and Evacuation, GTD, GTN

A Bombardier Beetle Pheropsophus aequinoctialis (L.) (Insecta: Coleoptera: Carabidae)

Pheropsophus aequinoctialis (L.) is a ground beetle in the tribe, Brachinini, native to parts of South and Central America. Ground beetles of this tribe are commonly referred to as bombardier beetles due to their ability to produce a powerful and hot defensive chemical spray directed at would-be predators. This spray is capable of harming humans, resulting in discomfort, physical burns (due to the spray temperature), and possibly contact dermatitis. The adults of this species are nocturnal and believed to be generalist predators and scavengers. However, larval stages appear to depend on an exclusive diet of mole cricket eggs. As such, Pheropsophus aequinoctialis may have potential use as a biological control agent against certain invasive mole cricket pests in North America. This article describes this insects biology, development, and behavior.&#x0D; Also published on the Featured Creatures website at http://entnemdept.ufl.edu/Creatures/BeneFICIAL/beetles/Pheropsophus_aequinoctialis.html

Diagnostic and prognostic significance of serum beta hCG level in various gestational trophoblastic diseases

Introduction: Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. Risk factors of GTD include extreme of reproductive age, multiparity, smoking, alcohol consumption, lower socioeconomic class etc. Materials and Methods: The present study was descriptive, observational, analytical type done in Department of Pathology at M.P. Shah Medical College Jamnagar. All cases clinically suspected of GTD were included and its correlation with serum beta hCG was studied. The cases of GTD were classified according to WHO classification. Estimation of serum beta hCG level was done by using Indirect Sandwich Enzyme Linked Immunosorbent Assay (ELISA). Results: During study period of 1 year from October 2019 to September 2020, 150 sample received out of which 16 cases were diagnosed as GTD. Most of the cases were of hydatidiform moles, few cases of choriocarcinoma and Placental Site Trophoblastic Tumour (PSTT). The common clinical presentation was per vaginal bleeding and amenorrhea. In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD was done. Conclusion: Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination and serum beta hCG level are helpful for confirmatory diagnosis. Follow up beta hCG level is very useful indicator to detect these lesions and its recurrences.

Pathology of gestational trophoblastic disease (GTD)

Gestational trophoblastic disease (GTD) is subclassified into hydatidiform mole (HM), gestational trophoblastic tumours (GTT) and non-neoplastic trophoblastic lesions. HM, partial and complete, originate from villous trophoblast and are considered as preneoplastic conditions. The risk for the development of persistent GTD, mostly as invasive HM, ranges from 0.5% to 20%, which depends on the type of molar pregnancy. The risk of development of trophoblastic tumour after PHM is <0.5% and 2%-3% after CHM. GTT represent a spectrum of neoplasms that originates from the intermediate, largely extravillous, trophoblast and these include choriocarcinoma (CC), placental site trophoblastic tumour (PSTT), epithelioid trophoblastic tumour (ETT) and mixed trophoblastic tumour. Among tumour like conditions, exaggerated placental site reaction (EPSR) and placental site nodule (PSN) (s)/plaque (s) are included. The morphological appearances of HM can be mimicked by abnormal (non-molar) villous lesions, and similarly, GTT can be mimicked both by non-malignant tumour-like conditions and non-gestational tumours with trophoblastic differentiation, which add to the diagnostic dilemma of these rare conditions. GTT have a favourable prognosis and better response to specific chemotherapeutic regimens when compared with non-gestational malignant genital tract neoplasms. The correct diagnosis and classification of these rare conditions are therefore important. This article focusses on the morphological appearances, immunocytochemistry as an aid in the diagnosis and the changes in current WHO classification of GTDs (WHO 2020).

Hipertireoidismo clínico em paciente com mola hidatiforme: relato de caso

Introdução: A doença trofoblástica gestacional (DTG) constitui um grupo de doenças responsável pela produção de elevados títulos de hCG, podendo levar a possíveis complicações como hipertireoidismo e, em situações mais graves, a crise tireotóxica. O hipertireoidismo está presente em apenas 5% dos casos de DTG, sendo importante seu diagnóstico precoce. Relato de Caso: Paciente feminina, 49 anos, G6PC2A3, apresentou-se no pronto socorro relatando sangramento vaginal irregular por 4 meses, hiperêmese, irritabilidade, tremores, palpitações, xerostomia e histórico de abortos de repetição. Ao exame ginecológico, notou-se sangramento em borra de café através do orifício externo do colo uterino, e ao toque bimanual, massa pélvica acima da cicatriz umbilical. USG/TV mostrou volume uterino de 1302 cc³ e imagens correspondentes à DTG. TSH e T4L de 0,015 mU/L (VR: 0,4 – 4,5 mU/L) e 2,34 ng/dL (VR: 0,7 – 1,8 ng/dL) respectivamente, e dosagem plasmática do BhCG &gt; 225.000 mUI/mL. Ao exame físico, demonstrou tireoide discretamente aumentada de consistência parenquimatosa e reflexo aquileu pouco exaltado. Ausência de histórico familiar para tireoidopatias e rastreio dos anticorpos anti-TPO, anti-TG e TRAb negativo. A paciente foi submetida a Aspiração Manual Intrauterina (AMIU). Em razão da manutenção dos níveis elevados de BhCG, foi solicitado nova USG/TV cujo resultado sugeriu DTG. Devido ao alto risco de neoplasia, ausência de focos metastáticos e prole constituída, optou-se por realizar histerectomia total abdominal, com salpingectomia bilateral e preservação dos ovários bilateralmente, como forma de tratamento. O TSH normalizou em 0,5 mU/L após procedimento cirúrgico. O histopatológico evidenciou Mola Invasora. Conclusão: Doenças que cursam com elevação do hCG podem levar a um quadro de hipertireoidismo secundário. Apesar desta patologia estar presente em apenas 5% dos casos de DTG, o médico não pode ignorar a importância de sua investigação para um diagnóstico precoce, com vistas a evitar complicações mais severas como por exemplo, a crise tireotóxica.