What is the perioperative management of gestational trophoblastic disease (GTD) associated hyperthyroidism before suction curettage?

From the Guidelines

Perioperative management of GTD-associated hyperthyroidism before suction curettage is crucial to prevent complications.

Key Considerations

• The management of gestational trophoblastic disease (GTD) associated hyperthyroidism before suction curettage involves careful assessment and staging of the disease, as well as consideration of the patient's overall health and fertility wishes 1.
• Suction dilation and curettage (D&C) under ultrasound control is the safest method of evacuation to ensure adequate emptying of uterine contents and to avoid uterine perforation 1.
• Uterotonic agents (e.g., methylergonovine and/or prostaglandins) should be administered during the procedure and continued for several hours postoperatively to reduce the risk of heavy bleeding 1.
• Rho(D) immunoglobulin should be administered at the time of evacuation to patients with Rh-negative blood types 1.
• Prophylactic chemotherapy at the time of uterine evacuation is controversial and may reduce the incidence of postmolar GTN by 3% to 8%, but the evidence is not sufficient to support standard administration 1.

Hyperthyroidism Management

• Hyperthyroidism associated with GTD should be managed with beta-blockers and antithyroid medications as needed to control symptoms and prevent complications 1.
• Close monitoring of the patient's thyroid function and overall health is essential during the perioperative period to ensure optimal management of hyperthyroidism and GTD 1.

From the Research

Perioperative Management of GTD-Associated Hyperthyroidism

The perioperative management of gestational trophoblastic disease (GTD) associated hyperthyroidism before suction curettage involves several key considerations:

• Early recognition and timely preoperative management are crucial for favorable outcomes and prevention of thyroid storm 2
• Empiric treatment for prevention of potential impending thyroid storm should be initiated prior to operative uterine evacuation 2
• A multidisciplinary approach, including Gynecology, Anesthesiology, and Endocrinology services, is essential for managing GTD-associated hyperthyroidism 2

Treatment Options

Various treatment options are available for managing GTD-associated hyperthyroidism, including:

• Antithyroid medication, such as propylthiouracil or methimazole, to control hyperthyroidism 3
• Beta-blockers, such as propranolol, to manage symptoms of hyperthyroidism 3
• Lugol's iodine and hydrocortisone may also be used in the prophylactic management of thyroid storm 3

Importance of Early Detection

Early detection of GTD and hyperthyroidism is critical to prevent development of severe complications, including thyroid storm-induced multi-organ failure, ARDS, and pulmonary hypertension 4

• Evaluation of thyroid function prior to operation, especially with high quantitative hCG, should be performed to avoid severe complications 5

Surgical Therapy

Surgical therapy, including suction dilation and curettage and hysterectomy, plays a role in the management of GTD 6

• Hysterectomy may be used as an adjunct to the primary management of selected patients with malignant GTD 6