Thyreotoxicosis in Early Pregnancy with Partial Cystic Mole - A Case Report

Introduction: With an incidence of 1:2 000-1:3 000 in Europe, mole pregnancy is rare. Partial mole is a benign form of gestational trophoblastic disease in which triploidy is thought to be caused by the insemination of an ovum by 2 sperms. A vital embryo is often dystrophic and growth retarded. The disease can present with vaginal bleeding, secondary anaemia, jaundice, signs of gestosis, as well as hyperthyroidism. Case history: A 29-year-old, 2G1P, visited our hospital in the 13 + 3 week of gestation for first trimester screening of trisomy 21. The patient was re-appointed for an ultrasound scan at 16 weeks of gestation to follow-up the appearance of a cystic, hyperplasic placenta and minimal foetal pericardial effusion. She appeared at the 15 + 1 week gestation with acute upper abdominal pain, tachycardia, hypertension (up to 160/100 mmHg) and double elevated liver enzymes. The performed ultrasound scan revealed a hydratiform placenta along with symmetrical foetal intrauterine growth retardation (IUGR). A cytogenetic examination revealed a triploidy (69, XXY). beta-hCG values approximated 2 225 000 IU/L. Due to the severe progression of hyperthyroid symptoms (TSH < 0.1 mU/L and fT4 29.6pmol/L) and the poor foetal prognosis, abortion was induced with intravaginal supplements of gemeprost after cervical priming with mifepriston. Hyperthyroidism symptoms were managed with methizol and propanolol. The clinical situation improved rapidly following the expulsion of all foetal tissues. Histopathology of all aborted specimens verified the suspected diagnosis of partial mole including a slightly dystrophic fetus. Patient follow-up did not reveal any further pathology of the thyroid nor of the cardiopulmonary situation. beta-hCH values sank to below detection levels after 12 weeks. Conclusions: Gestational trophoblastic disease should be considered in the differential diagnosis when acute onset of symptoms pointing to hyperthyroidism occurs in women of childbearing age.