Clinical predictors of hyperthyroidism in women with complete hydatidiform mole

Abstract

Introduction. The importance of complete hydatidiform mole (CHM), besides its propensity for malignant development, is the occurrence of serious clinical complications and potentially life-threatening conditions, such as hemorrhage, preeclampsia, respiratory failure and hyperthyroidism. The prevalence of hyperthyroidism in CHM presentation varies from 7% to 64%. Differentiating CHM presentation between patients with and without hyperthyroidism is helpful when making recommendations that improve the initial treatment and follow-up after a molar pregnancy. Objectives. The purpose of this study is to: 1) estimate the prevalence of hyperthyroidism in CHM patients at presentation; 2) identify clinical factors associated with hyperthyroidism; and 3) follow thyroid function until thyroid-stimulating hormone (TSH) and free thyroxine (FT4) serum concentration recovery after uterine evacuation of CHM. Methods. A cohort study that will include CHM patients who have been diagnosed, treated and followed-up at the Botucatu Trophoblastic Diseases Center of São Paulo State University between 2002 and 2016. Clinical data will be extracted from databases and medical records. The hyperthyroidism outcome will be defined as subclinical or overt hyperthyroidism. Subclinical hyperthyroidism will be determined by TSH value below the lower limit of normal range (< 0,35µUI/mL), but with free T4 within the normal range. Overt hyperthyroidism will be defined biochemically by a low or undetectable TSH and a higher than normal free T4 value, with or without symptoms. The analysis of the occurrence of hyperthyroidism on the basis of clinical factors in the presentation of CHM will be effected by multiple logistic regression.Keywords: Hydatidiform mole, Hyperthyroidism, Human chorionic gonadotropin. (AU)