The Use of Plasmapheresis for Rapid Hormonal Control in Severe Hyperthyroidism Caused by a Partial Molar Pregnancy

Abstract

The hormone human chorionic gonadotropin (hCG), secreted by molar tissue, is structurally similar to thyroid-stimulating hormone (TSH). Hyperthyroidism in trophoblastic disease is thought to be the result of TSH receptor activation by extremely elevated levels of hCG. Significant elevations in hCG levels are less common in cases of partial moles. We describe a patient with partial molar pregnancy in which the levels of hCG and thyroid hormones were significantly high. It was not possible to decrease the elevated thyroid hormone concentrations to safer levels using medical treatment strategies only. Since the patient's vaginal bleeding increased gradually, plasmapheresis was used to rapidly control the thyroid hormones during the preoperative preparation of the patient for anesthesia and surgery. After the evacuation of the molar tissue, the levels of the thyroid hormones detected after the plasmapheresis started to decrease even further. Plasmapheresis may be used as an alternative to antithyroid medication for the rapid control of thyroid hormones in cases of severe hyperthyroidism caused by molar pregnancy.