Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.ygyno.2022.01.037 http://hdl.handle.net/11449/230365 |
Resumo: | Objectives: To identify possible clinical factors associated with hyperthyroidism at presentation and to assess post-evacuation thyroid function in women with complete hydatidiform mole (CHM). Methods: This observational study included women with CHM attending a specialized Brazilian center in 2002–2018. Clinical and laboratory data (serum hCG, TSH, fT4) were collected at presentation. Factors associated with hyperthyroidism were assessed by logistic regression. Receiver-operating characteristic curves were built to determine the hCG cutoff for predicting hyperthyroidism at CHM presentation. Post-molar evacuation follow-up included clinical assessment and close thyroid function monitoring. Results: Of 137 CHM patients, 69 (50.3%) had hyperthyroidism of any type (43.5% subclinical, 56.5% overt) at presentation. Uterine fundal height > 16 cm or > gestational age (GA), and theca lutein cysts >6 cm were significantly associated with both subclinical and overt hyperthyroidism. The optimal hCG cutoff for predicting hyperthyroidism was 430,559 IU/L (sensitivity 85.5%, specificity 83.8%). Post-evacuation hyperthyroidism/transient hypothyroidism conversion was observed in 13% of the women with hyperthyroidism at presentation. Among the patients not showing conversion to hypothyroidism, median time for TSH normalization was 2 and 3 weeks for subclinical and overt hyperthyroidism, respectively. In the women with overt hyperthyroidism, fT4 was normalized at 2 weeks. Conclusions: Uterine fundal height > 16 cm, uterine fundal height > GA, theca lutein cysts >6 cm, and hCG >400,000 IU/L at presentation are associated with greater risk of hyperthyroidism and its complications. Close monitoring thyroid function during postmolar follow-up showed that, as thyroid hormones are normalized within 2–3 weeks post-evacuation, the use of beta-blockers or antithyroid drugs can be rapidly discontinued. |
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Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidismHuman chorionic gonadotropinHydatidiform moleHyperthyroidismThyroid functionThyrotoxicosisObjectives: To identify possible clinical factors associated with hyperthyroidism at presentation and to assess post-evacuation thyroid function in women with complete hydatidiform mole (CHM). Methods: This observational study included women with CHM attending a specialized Brazilian center in 2002–2018. Clinical and laboratory data (serum hCG, TSH, fT4) were collected at presentation. Factors associated with hyperthyroidism were assessed by logistic regression. Receiver-operating characteristic curves were built to determine the hCG cutoff for predicting hyperthyroidism at CHM presentation. Post-molar evacuation follow-up included clinical assessment and close thyroid function monitoring. Results: Of 137 CHM patients, 69 (50.3%) had hyperthyroidism of any type (43.5% subclinical, 56.5% overt) at presentation. Uterine fundal height > 16 cm or > gestational age (GA), and theca lutein cysts >6 cm were significantly associated with both subclinical and overt hyperthyroidism. The optimal hCG cutoff for predicting hyperthyroidism was 430,559 IU/L (sensitivity 85.5%, specificity 83.8%). Post-evacuation hyperthyroidism/transient hypothyroidism conversion was observed in 13% of the women with hyperthyroidism at presentation. Among the patients not showing conversion to hypothyroidism, median time for TSH normalization was 2 and 3 weeks for subclinical and overt hyperthyroidism, respectively. In the women with overt hyperthyroidism, fT4 was normalized at 2 weeks. Conclusions: Uterine fundal height > 16 cm, uterine fundal height > GA, theca lutein cysts >6 cm, and hCG >400,000 IU/L at presentation are associated with greater risk of hyperthyroidism and its complications. Close monitoring thyroid function during postmolar follow-up showed that, as thyroid hormones are normalized within 2–3 weeks post-evacuation, the use of beta-blockers or antithyroid drugs can be rapidly discontinued.Postgraduation Program in Tocoginecology Botucatu Medical School UNESP-São Paulo State University, SPBotucatu Trophoblastic Disease Center Clinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics UNESP-São Paulo State University, SPClinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics UNESP-São Paulo State University, SPEndocrinology Clinic Department of Internal Medicine Botucatu Medical School UNESP-São Paulo State University, SPNew England Trophoblastic Disease Center Division of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology Brigham and Women's Hospital Harvard Medical SchoolDepartment of Obstetrics and Gynecology Division of Gynecologic Oncology Brigham and Women's HospitalRio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal University Antonio Pedro University Hospital Fluminense Federal University, RJPostgraduation Program in Tocoginecology Botucatu Medical School UNESP-São Paulo State University, SPBotucatu Trophoblastic Disease Center Clinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics UNESP-São Paulo State University, SPClinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics UNESP-São Paulo State University, SPEndocrinology Clinic Department of Internal Medicine Botucatu Medical School UNESP-São Paulo State University, SPUniversidade Estadual Paulista (UNESP)Harvard Medical SchoolBrigham and Women's HospitalFluminense Federal UniversityRamos, Marcos Montanha [UNESP]Maesta, Izildinha [UNESP]de Araújo Costa, Roberto Antonio [UNESP]Mazeto, Glaucia M.F.S. [UNESP]Horowitz, Neil S.Elias, Kevin M.Braga, AntonioBerkowitz, Ross S.2022-04-29T08:39:29Z2022-04-29T08:39:29Z2022-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1016/j.ygyno.2022.01.037Gynecologic Oncology.1095-68590090-8258http://hdl.handle.net/11449/23036510.1016/j.ygyno.2022.01.0372-s2.0-85124383244Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengGynecologic Oncologyinfo:eu-repo/semantics/openAccess2024-08-16T14:07:22Zoai:repositorio.unesp.br:11449/230365Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-16T14:07:22Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
title |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
spellingShingle |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism Ramos, Marcos Montanha [UNESP] Human chorionic gonadotropin Hydatidiform mole Hyperthyroidism Thyroid function Thyrotoxicosis |
title_short |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
title_full |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
title_fullStr |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
title_full_unstemmed |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
title_sort |
Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism |
author |
Ramos, Marcos Montanha [UNESP] |
author_facet |
Ramos, Marcos Montanha [UNESP] Maesta, Izildinha [UNESP] de Araújo Costa, Roberto Antonio [UNESP] Mazeto, Glaucia M.F.S. [UNESP] Horowitz, Neil S. Elias, Kevin M. Braga, Antonio Berkowitz, Ross S. |
author_role |
author |
author2 |
Maesta, Izildinha [UNESP] de Araújo Costa, Roberto Antonio [UNESP] Mazeto, Glaucia M.F.S. [UNESP] Horowitz, Neil S. Elias, Kevin M. Braga, Antonio Berkowitz, Ross S. |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (UNESP) Harvard Medical School Brigham and Women's Hospital Fluminense Federal University |
dc.contributor.author.fl_str_mv |
Ramos, Marcos Montanha [UNESP] Maesta, Izildinha [UNESP] de Araújo Costa, Roberto Antonio [UNESP] Mazeto, Glaucia M.F.S. [UNESP] Horowitz, Neil S. Elias, Kevin M. Braga, Antonio Berkowitz, Ross S. |
dc.subject.por.fl_str_mv |
Human chorionic gonadotropin Hydatidiform mole Hyperthyroidism Thyroid function Thyrotoxicosis |
topic |
Human chorionic gonadotropin Hydatidiform mole Hyperthyroidism Thyroid function Thyrotoxicosis |
description |
Objectives: To identify possible clinical factors associated with hyperthyroidism at presentation and to assess post-evacuation thyroid function in women with complete hydatidiform mole (CHM). Methods: This observational study included women with CHM attending a specialized Brazilian center in 2002–2018. Clinical and laboratory data (serum hCG, TSH, fT4) were collected at presentation. Factors associated with hyperthyroidism were assessed by logistic regression. Receiver-operating characteristic curves were built to determine the hCG cutoff for predicting hyperthyroidism at CHM presentation. Post-molar evacuation follow-up included clinical assessment and close thyroid function monitoring. Results: Of 137 CHM patients, 69 (50.3%) had hyperthyroidism of any type (43.5% subclinical, 56.5% overt) at presentation. Uterine fundal height > 16 cm or > gestational age (GA), and theca lutein cysts >6 cm were significantly associated with both subclinical and overt hyperthyroidism. The optimal hCG cutoff for predicting hyperthyroidism was 430,559 IU/L (sensitivity 85.5%, specificity 83.8%). Post-evacuation hyperthyroidism/transient hypothyroidism conversion was observed in 13% of the women with hyperthyroidism at presentation. Among the patients not showing conversion to hypothyroidism, median time for TSH normalization was 2 and 3 weeks for subclinical and overt hyperthyroidism, respectively. In the women with overt hyperthyroidism, fT4 was normalized at 2 weeks. Conclusions: Uterine fundal height > 16 cm, uterine fundal height > GA, theca lutein cysts >6 cm, and hCG >400,000 IU/L at presentation are associated with greater risk of hyperthyroidism and its complications. Close monitoring thyroid function during postmolar follow-up showed that, as thyroid hormones are normalized within 2–3 weeks post-evacuation, the use of beta-blockers or antithyroid drugs can be rapidly discontinued. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-04-29T08:39:29Z 2022-04-29T08:39:29Z 2022-01-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.ygyno.2022.01.037 Gynecologic Oncology. 1095-6859 0090-8258 http://hdl.handle.net/11449/230365 10.1016/j.ygyno.2022.01.037 2-s2.0-85124383244 |
url |
http://dx.doi.org/10.1016/j.ygyno.2022.01.037 http://hdl.handle.net/11449/230365 |
identifier_str_mv |
Gynecologic Oncology. 1095-6859 0090-8258 10.1016/j.ygyno.2022.01.037 2-s2.0-85124383244 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Gynecologic Oncology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1808128163977363456 |