Background/Objectives: Gestational trophoblastic disease (GTD) is a group of disorders including complete, partial, and invasive/metastatic hydatidiform moles, as well as gestational trophoblastic neoplasia (GTN) (choriocarcinoma; placental site trophoblastic tumor, PSTT; epithelioid trophoblastic tumor, ETT; or mixed forms). These entities are characterized by increased trophoblast proliferation, rarely complicated by hyperthyroidism.Methods: Our systematic literature review (PRISMA guidelines; PubMed, Web of Science, and Scopus databases) searched for histologically confirmed cases of GTN associated with clinical or subclinical hyperthyroidism. We described the clinical–pathologic features and the pathways of hyperthyroidism in GTD.Results: We identified just 32 choriocarcinomas and one PSTT; other non-histologically confirmed cases could have been identified, as some patients received a clinical diagnosis based on serum human chorionic gonadotropin (hCG) levels and imagining data and were treated accordingly. As regards choriocarcinomas, patients’ age range was 15–45 (mean 27) years. Metastases involved the lungs (53%), brain (25%), and liver (19%) (less frequently, the kidneys, spleen, ovaries, vagina, pelvis/abdomen, or thyroid). The time to recurrence range was 1–36 (mean 12) months. On follow-up, 10 patients (32%) were alive with disease and 6 (19%) showed no evidence of disease, while most of the women (15 cases, 48%) died of disease. The hCG level range was 10,000–3,058,000,000 (mean 128,957,613) IU/L. At least some symptoms and/or signs of hyperthyroidism were evident with variable intensity in most cases and significantly improved within 2–3 weeks after treatment.Conclusions: Increased trophoblast proliferation could stimulate thyroid function via increasing the half-life of thyroxine-binding globulin. Secondly, increased hCG demonstrates cross-reactivity with the thyroid-stimulating hormone due to similar α-subunits. Moreover, basic isoforms of hCG may facilitate thyrotropic activity.
背景/目的：妊娠滋养细胞疾病（GTD）是一组疾病，包括完全性、部分性和侵袭性/转移性葡萄胎，以及妊娠滋养细胞肿瘤（GTN）（绒毛膜癌；胎盘部位滋养细胞肿瘤，PSTT；上皮样滋养细胞肿瘤，ETT；或混合型）。这些疾病的特征是滋养细胞增殖增加，极少并发甲状腺功能亢进。方法：我们进行了系统性文献综述（遵循PRISMA指南；检索PubMed、Web of Science和Scopus数据库），以查找经组织学确诊且伴有临床或亚临床甲状腺功能亢进的GTN病例。我们描述了GTD中甲状腺功能亢进的临床病理特征及其发生途径。结果：我们仅确定了32例绒毛膜癌和1例PSTT；可能还存在其他未经组织学确诊的病例，因为部分患者仅依据血清人绒毛膜促性腺激素（hCG）水平和影像学数据获得临床诊断并接受了相应治疗。关于绒毛膜癌，患者年龄范围为15-45岁（平均27岁）。转移部位涉及肺部（53%）、脑部（25%）和肝脏（19%）（较少见于肾脏、脾脏、卵巢、阴道、盆腔/腹部或甲状腺）。复发时间范围为1-36个月（平均12个月）。随访期间，10名患者（32%）带病生存，6名（19%）无疾病证据，而大多数女性（15例，48%）死于该疾病。hCG水平范围为10,000–3,058,000,000（平均128,957,613）IU/L。在大多数病例中，至少出现了一些强度不一的甲状腺功能亢进症状和/或体征，并在治疗后2-3周内显著改善。结论：滋养细胞增殖增加可能通过延长甲状腺素结合球蛋白的半衰期来刺激甲状腺功能。其次，由于相似的α亚基，hCG升高与促甲状腺激素存在交叉反应性。此外，hCG的碱性亚型可能增强促甲状腺活性。
肿瘤(癌症)患者之家