From the Research
Perioperative Management of Hyperthyroidism Caused by HCG Elevation
The guidelines for perioperative management of hyperthyroidism caused by Human Chorionic Gonadotropin (HCG) elevation are as follows:
- Hyperthyroidism due to gestational trophoblastic disease (GTD) is a rare but potentially life-threatening condition that requires early recognition and timely preoperative management 1, 2, 3.
- Pregnant patients with GTD should be evaluated for hyperthyroidism, and in cases of severe hyperthyroidism, antithyroid treatment should be initiated before evacuation of the mole 2.
- The pathophysiology of hyperthyroidism in GTD is well-investigated, with placental trophoblastic tissue secreting excessive hCG, which has enhanced thyrotropic activity compared to normal hCG 3, 4.
- Hyperthyroidism can be definitively managed with surgical evacuation of the uterus, and early detection of GTD is critical to prevent development of hyperthyroidism and its associated complications 3.
- Spinal anesthesia can be safely administered and has a protective role in preventing thyroid crisis in patients with hyperthyroidism secondary to molar pregnancy 2.
- Thyroidectomy can be performed safely in patients with uncontrolled hyperthyroidism, and the risk of thyroid storm is low 5.
Key Considerations
- The incidence and prevalence of hyperthyroidism in GTD vary worldwide, with lower rates associated with high uptake of early antenatal screening and early GTD detection 3.
- No clear risk factors for hyperthyroidism in GTD have been identified, and future studies should explore risk factors for hyperthyroidism in GTD to facilitate earlier identification of high-risk women 3.
- Hyperthyroidism should be recognized as an important perioperative consideration for women undergoing surgery for GTD, and requires appropriate management 3.