Chale-Matsau Bettina, Mokoena Samantha, Kemp Tanja, Pillay Tahir S
Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria and National Health Laboratory Service Tshwane Academic Division, South Africa.
Division of Endocrinology, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, South Africa.
Clin Chim Acta. 2020 Dec;511:24-27. doi: 10.1016/j.cca.2020.09.028. Epub 2020 Sep 25.
Molar pregnancy is a complication characterised by abnormal benign or malignant proliferation of trophoblastic cells resulting in markedly elevated β-hCG (human chorionic gonadotrophin) levels, an established marker for the presence of the disease. Owing to the structural homology between β-hCG and TSH, the raised β-hCG can result in secondary hyperthyroidism.
Two patients aged 20 (Case 1) and 31 years (Case 2) presented to the emergency department within a few days of each other complaining of vaginal bleeding associated with abdominal pain. Ultrasound evaluation, β-hCG and thyroid function tests were performed on both patients.
Both had elevated β-hCG levels and ultrasound evidence of molar pregnancy and were diagnosed with gestational trophoblastic disease (GTD) associated with hyperthyroidism based on thyroid function test results. Case 1 had lower β-hCG levels and free T4 levels compared with Case 2 but clinical assessment of the former revealed severe illness and more complicated course with the development of a thyroid storm. Case 2 had β-hCG levels almost double those of Case 1, yet was stable and her levels decreased much faster, reaching and maintaining undetectable levels.
These cases demonstrate that the β-hCG levels do not always correlate with disease severity and prognosis in patients with GTD.
葡萄胎是一种并发症，其特征为滋养层细胞异常良性或恶性增殖，导致β - 人绒毛膜促性腺激素（β - hCG）水平显著升高，β - hCG是该疾病存在的既定标志物。由于β - hCG与促甲状腺激素（TSH）存在结构同源性，升高的β - hCG可导致继发性甲状腺功能亢进。
两名患者，年龄分别为20岁（病例1）和31岁（病例2），在几天内先后前往急诊科，均主诉有阴道出血伴腹痛。对两名患者均进行了超声评估、β - hCG检测及甲状腺功能检查。
两名患者β - hCG水平均升高，超声检查均有葡萄胎证据，根据甲状腺功能检查结果，均被诊断为与甲状腺功能亢进相关的妊娠滋养细胞疾病（GTD）。与病例2相比，病例1的β - hCG水平及游离T4水平较低，但对前者的临床评估显示病情严重，病程更复杂，且出现了甲状腺危象进展。病例2的β - hCG水平几乎是病例1的两倍，但病情稳定，其β - hCG水平下降更快，降至并维持在检测不到的水平。
这些病例表明，GTD患者的β - hCG水平并不总是与疾病严重程度及预后相关。
