Abstract
Introduction
Human chorionic gonadotropin is regarded as, at least, one of the main factors responsible for hyperemesis gravidarum by direct stimulation of the thyroid gland on the basis of a close homology to the structure of TSH. However, questions to this theory of hCG-induced gestational hyperthyroidism still remain.
Case report
We present for the first time a rare case of hyperemesis gravidarum in a patient with a previous removed thyroid gland and an adequate thyroxin replacement. In this case report we present an extended hyperemesis gravidarum in a patient after total thyroidectomy and thus artificially well-set thyroid parameters.
Conclusion
Although transient hyperthyroidism is widely thought to be causative of a hyperemesis during pregnancy, this case report with a mildly hypothyroidism emphasizes that there might be other, yet unknown, factors that can cause such a severe complication.
References
Stricker R, Echenard M, Eberhart R, Chevailler MC, Perez V, Quinn FA (2007) Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol 157:509–514. doi:10.1530/EJE-07-0249
Mylonas I, Gingelmaier A, Kainer F (2007) Nausea and vomiting in pregnancy. Dtsch Arztebl 104:A-1821–A-1826
Yoshimura M, Hershman JM, Pang XP, Berg L, Pekary AE (1993) Activation of the thyrotropin (TSH) receptor by human chorionic gonadotropin and luteinizing hormone in Chinese hamster ovary cells expressing functional human TSH receptors. J Clin Endocrinol Metab 77:1009–1013. doi:10.1210/jc.77.4.1009
Panesar NS, Li CY, Rogers MS (2001) Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women. Acta Obstet Gynecol Scand 80:519–524. doi:10.1034/j.1600-0412.2001.080006519.x
Smallridge RC, Glinoer D, Hollowell JG, Brent G (2005) Thyroid function inside and outside of pregnancy: what do we know and what don’t we know? Thyroid 15:54–59. doi:10.1089/thy.2005.15.54
Glinoer D (2004) The regulation of thyroid function during normal pregnancy: importance of the iodine nutrition status. Best Pract Res Clin Endocrinol Metab 18:133–152. doi:10.1016/j.beem.2004.03.001
Murata T, Suzuki S, Takeuchi T, Takeshita T (2006) Relation between plasma adenosine and serum TSH levels in women with hyperemesis gravidarum. Arch Gynecol Obstet 273:331–336. doi:10.1007/s00404-005-0091-1
Al-Yatama M, Diejomaoh M, Nandakumaran M, Monem RA, Omu AE, Al Kandari F (2002) Hormone profile of Kuwaiti women with hyperemesis gravidarum. Arch Gynecol Obstet 266:218–222. doi:10.1007/s004040100210
Rodien P, Jordan N, Lefevre A, Royer J, Vasseur C, Savagner F, Bourdelot A, Rohmer V (2004) Abnormal stimulation of the thyrotrophin receptor during gestation. Hum Reprod Update 10:95–105. doi:10.1093/humupd/dmh008
Tsuruta E, Tada H, Tamaki H, Kashiwai T, Asahi K, Takeoka K, Mitsuda N, Amino N (1995) Pathogenic role of asialo human chorionic gonadotropin in gestational thyrotoxicosis. J Clin Endocrinol Metab 80:350–355. doi:10.1210/jc.80.2.350
Goodwin TM, Montoro M, Mestman JH, Pekary AE, Hershman JM (1992) The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab 75:1333–1337. doi:10.1210/jc.75.5.1333
Hershman JM (1999) Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. Thyroid 9:653–657. doi:10.1089/thy.1999.9.653
Schiff MA, Reed SD, Daling JR (2004) The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum. BJOG 111:27–30. doi:10.1046/j.1471-0528.2003.00005.x
Depue RH, Bernstein L, Ross RK, Judd HL, Henderson BE (1987) Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study. Am J Obstet Gynecol 156:1137–1141
Jordan V, Grebe SK, Cooke RR, Ford HC, Larsen PD, Stone PR, Salmond CE (1999) Acidic isoforms of chorionic gonadotrophin in European and Samoan women are associated with hyperemesis gravidarum and may be thyrotrophic. Clin Endocrinol (Oxf) 50:619–627. doi:10.1046/j.1365-2265.1999.00702.x
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Blankenstein, T.J.F., Kainer, F., Friese, K. et al. Extended hyperemesis gravidarum in a patient after total thyroidectomy. Arch Gynecol Obstet 280, 1029–1031 (2009). https://doi.org/10.1007/s00404-009-1026-z
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DOI: https://doi.org/10.1007/s00404-009-1026-z