Muzio María Julia, Acosta Paula L, Canosa Victoria, Siguelboin Daniel, Canciani Juan José, Dal Verme Agustín
Servicio de Clínica Médica, Sanatorio San José, Buenos Aires, Argentina.
Servicio de Anatomía Patológica, Sanatorio San José, Buenos Aires, Argentina.
Medicina (B Aires). 2019;79(5):411-414.
Hyperthyroidism is a relatively frequent condition with multiple causes. The most common cause is Graves' disease; followed by hyperthyroid multinodular goiter and toxic adenoma. Association between hyperthyroidism and cancer is infrequent in daily practice. We present the case of a 42-year-old man who developed severe symptoms of hyperthyroidism within a period of two months. Physical examination revealed significant hepatomegaly. Testicular examination proved normal. Imaging studies showed the presence of multiple hepatic solid lesions consistent with metastases. After discarding the most common causes of hyperthyroidism and primary thyroid gland neoplasm, the possibility of molecular mimicry was considered through human chorionic gonadotrophin production. Critical high values of this hormone were found and choriocarcinoma histological diagnosis was confirmed through a liver biopsy. We consider that the recognition of this rare mechanism of hyperthyroidism may be a clue permitting a faster diagnosis, particularly when extragonadal tumors are present.
甲状腺功能亢进是一种病因多样且相对常见的病症。最常见的病因是格雷夫斯病；其次是甲状腺功能亢进性多结节性甲状腺肿和毒性腺瘤。在日常临床实践中，甲状腺功能亢进与癌症之间的关联并不常见。我们报告一例42岁男性病例，该患者在两个月内出现了严重的甲状腺功能亢进症状。体格检查发现肝脏明显肿大。睾丸检查结果正常。影像学检查显示存在多个符合转移瘤表现的肝脏实性病变。在排除甲状腺功能亢进和原发性甲状腺肿瘤的最常见病因后，考虑通过人绒毛膜促性腺激素分泌情况来判断分子模拟的可能性。发现该激素水平严重升高，并通过肝脏活检确诊为绒毛膜癌。我们认为，认识到这种罕见的甲状腺功能亢进机制可能是实现更快诊断的一条线索，尤其是在存在性腺外肿瘤的情况下。
