一例由胎盘部位滋养细胞肿瘤引起的短暂性甲状腺功能亢进症。

A case of transient hyperthyroidism induced by placental site trophoblastic tumor.

作者信息

Ishii Sumire, Hirayama Takashi, Saeki Harumi, Fujino Kazunari, Terao Yasuhisa, Itakura Atsuo

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Bunkyō, Japan.

Department of Pathology and Oncology, Faculty of Medicine, Juntendo University, Bunkyō, Japan.

出版信息

J Obstet Gynaecol Res. 2025 Jan;51(1):e16193. doi: 10.1111/jog.16193.

DOI:10.1111/jog.16193

PMID:39722226

Abstract

We report a case of placental site trophoblastic tumor (PSTT) with transient hyperthyroidism. A 29-year-old gravida 2 para 2 woman presented with abnormal genital bleeding 6 months after delivery. Endometrial histology suggested PSTT. Serum human chorionic gonadotropin (hCG) was 117 mIU/mL and serum estradiol (E2) were 51 pg/mL. She reported increased appetite, sweating, fatigue, and 7-kg weight loss within 3 months. Blood samples showed a thyroid-stimulating hormone (TSH) level <0.01 μIU/mL, FT3: 24.3 pg/mL, FT4: 5.3 ng/mL. The patient was diagnosed with hyperthyroidism. After thyroid function normalized, laparoscopic hysterectomy and bilateral salpingectomy were performed. Two years postsurgery, there was no recurrence, and thyroid function improved. The hCG produced from gestational trophoblastic disease has stronger TSH activity than that from gestational trophoblasts. However, in PSTT, the E2 level, which increases thyroid-binding proteins and suppresses elevated thyroid hormone levels, is low and may induce hyperthyroidism. In cases of suspected PSTT, thyroid function should be evaluated when hyperthyroid symptoms are present.

摘要

我们报告一例伴有短暂性甲状腺功能亢进的胎盘部位滋养细胞肿瘤（PSTT）。一名29岁、孕2产2的女性在分娩后6个月出现异常生殖器出血。子宫内膜组织学检查提示为PSTT。血清人绒毛膜促性腺激素（hCG）为117 mIU/mL，血清雌二醇（E2）为51 pg/mL。她自述食欲增加、多汗、疲劳，且在3个月内体重减轻了7千克。血液样本显示促甲状腺激素（TSH）水平<0.01 μIU/mL，游离三碘甲状腺原氨酸（FT3）：24.3 pg/mL，游离甲状腺素（FT4）：5.3 ng/mL。该患者被诊断为甲状腺功能亢进。甲状腺功能恢复正常后，进行了腹腔镜子宫切除术和双侧输卵管切除术。术后两年，无复发，甲状腺功能改善。妊娠滋养细胞疾病产生的hCG比妊娠滋养细胞产生的hCG具有更强的促甲状腺激素活性。然而，在PSTT中，可增加甲状腺结合蛋白并抑制甲状腺激素水平升高的E2水平较低，可能诱发甲状腺功能亢进。对于疑似PSTT的病例，出现甲状腺功能亢进症状时应评估甲状腺功能。