Department of Urology, Asklepios Hospital Altona, Hamburg, Germany.
Oncology. 2024;102(11):988-995. doi: 10.1159/000538634. Epub 2024 May 6.
Paraneoplastic hyperthyroidism (PH) has been reported in patients with testicular germ cell tumors (GCTs), sporadically. This disorder is caused by extremely elevated serum levels of beta-human chorionic gonadotropin (bHCG). To date, little is known about the prevalence of PH, and its clinical features are poorly understood. The aim of the present study was to analyze the relative frequency and clinical features of PH in GCTs and evaluate their effects on therapeutic outcomes.
A cohort of 438 patients treated for testicular GCT from 2017 to 2023 was retrospectively analyzed for histology, age, clinical stage, and presence of PH. The clinical features of the patients with PH were evaluated descriptively. The relative frequency of PH was compared among the subgroups using descriptive statistical methods.
Three patients with PH were identified; all had clinical symptoms of hyperthyroidism, suppressed serum levels of thyroid-stimulating hormone (TSH), and increased levels of tri-iodothyronin (fT3). All the patients had advanced, metastasized, and non-seminomatous GCTs. Serum bHCG levels ranged from 225,00 U/L to 1,520,000 U/L. The prevalence of PH was 0.7% in the entire GCT population and 60% in those with very high bHCG serum levels. All the patients received standard cisplatin-based chemotherapy along with thyrostatic treatment. The clinical symptoms of the hyperthyroidism rapidly disappeared. TSH levels normalized with decreasing bHCG levels. The PH treatment did not affect the therapeutic outcomes of the patients.
PH may occur in 0.7% of all patients with GCT but may be present in up to 60% of patients with very high levels of bHCG. Measuring serum levels of TSH and fT3 should be performed in addition to routine diagnostic measures in all patients with poor prognosis GCTs. Thyrostatic medication is recommended for patients with the clinical symptoms of hyperthyroidism. Early recognition of hyperthyroidism and prompt intervention will reduce comorbidity and help optimize therapeutic outcomes.
副肿瘤性甲状腺功能亢进症（PH）已在睾丸生殖细胞肿瘤（GCT）患者中偶有报道。这种疾病是由人绒毛膜促性腺激素β（bHCG）的血清水平极高引起的。迄今为止，人们对 PH 的患病率知之甚少，其临床特征也了解甚少。本研究旨在分析 GCT 中 PH 的相对频率及其临床特征，并评估其对治疗结果的影响。
回顾性分析了 2017 年至 2023 年期间接受睾丸 GCT 治疗的 438 例患者的组织学、年龄、临床分期和 PH 存在情况。描述性评估了 PH 患者的临床特征。使用描述性统计方法比较了 PH 亚组之间的相对频率。
发现 3 例 PH 患者，均有甲状腺功能亢进的临床症状，血清促甲状腺激素（TSH）水平受抑制，三碘甲状腺原氨酸（fT3）水平升高。所有患者均患有晚期、转移和非精原细胞瘤 GCT。血清 bHCG 水平范围为 225,000 U/L 至 1,520,000 U/L。PH 在整个 GCT 人群中的患病率为 0.7%，在 bHCG 血清水平非常高的患者中患病率为 60%。所有患者均接受标准顺铂为基础的化疗和甲状腺抑制治疗。甲状腺功能亢进的临床症状迅速消失。随着 bHCG 水平的降低，TSH 水平恢复正常。PH 治疗并未影响患者的治疗结果。
PH 可能发生在所有 GCT 患者的 0.7%中，但在 bHCG 水平非常高的患者中可能存在 60%。除了常规诊断措施外，所有预后不良的 GCT 患者均应测量 TSH 和 fT3 血清水平。对于有甲状腺功能亢进临床症状的患者，建议使用甲状腺抑制药物。早期识别甲状腺功能亢进并及时干预将减少合并症，有助于优化治疗结果。
