Molar gebeliğin tetiklediği tiroid krizinde anestezik yaklaşım [Anesthetic management in thyroid crisis triggered by molar pregnancy]

Abstract

Clinical thyrotoxicosis is one of the rare complications of molar pregnancy. The cause of the symptoms associated with hyperthyroidism in mol hydatiform is the thyrotrophic effects of high levels of β-hCG. The hCG molecule consists of α and β subunits; the α subunit is identical to TSH and the β subunit has a similar structure to TSH. In this case report it was aimed to discuss the anesthetic management of a dilatation and curettage case in a patient with mol hydatiform and thyroid crisis.

Keywords

• Hydatidiform mole, hyperthyroidism, anesthesia

Molar gebeliğin tetiklediği tiroid krizinde anestezik yaklaşım [Anesthetic management in thyroid crisis triggered by molar pregnancy]

Öz

Klinik tirotoksikoz molar gebeliğin nadir görülen komplikasyonlarından biridir. Mol hidatiformda hipertiroidi ile ilişkili semptomların sebebi; yüksek konsantrasyonlardaki β-hCG'nin tirotropik etkisidir. HCG molekülü α ve β subünitelerinden meydana gelir. α subunitesi TSH\'a birebir benzerken β subunitesi kısmi olarak benzer. Bu olgu sunumunda yeterli açlık süresi sağlanamayan dilatasyonal küretaj planlanan tiroid krizindeki mol hidatiformlu hastaya anestezik yaklaşımın tartışılması amaçlandı.

Anahtar Kelimeler

• Mol hidatiform, hipertiroidizm, anestezi

Kaynakça

1. Ozalp SS, Yalcin OT, Tanır HM. Hydatidiform mole in Turkey from 1932-2000. Int J Gynecol Obstet 2001;73 (3):257-8.
2. Berkowitz R S, Goldstein D P, DuBeshter B, Bernstein MR. Management of complete molar pregnancy. J Reprod Med 1987; 32 (9): 634-9.
3. Itzkowic D. Hydatidiform mole and thyrotoxicosis. A case re- port. Br J Obstet Gynaecol 1976; 83 (1): 86-9.
4. Hershman JM, Higgins HP. Hydatidiform mole: a cause of clini- cal hyperthyroidism. N Engl J Med 1971; 284 (11): 573-7.
5. Rajatanavin R, Chailurkit LO, Srisupandit S, Tungtrakul S, Bunyaratvej S. Trophoblastic hyperthyroidism: clinical and biochemical features of fi ve cases. Am J Med 1988;85 (2) :237-41.
6. Kenimer JG, Hershman JM, Higgins HP. The thyrotropin in hydatidiform moles is human chorionic gonadotropin. J Clin Endocrinol Metab 1975;40 (3) :482-91.
7. Hershman JM. Hyperthyroidism induced by trophoblastic thy- rotropin. Mayo Clin Proc 1972;47 (12) :913-8.
8. Narasimhan KL, Ghobrial MW, Ruby EB. Hyperthyroidism in the setting of gestational trophoblastic disease. Am J Med Sci 2002;323(5):285-7.

9. Sowers JR, Hershman JM, Carlson HE, Pekary AE. Effect of human chorionic gonadotropin on thyroid function in euthy- roid men. J Clin Endocrinol Metab 1978;47(4):898-901.
10. Tomer Y, Huber GK, Davies TF. Human chorionic gonado- tropin (hCG) interacts directly with recombinant human TSH receptors. J Clin Endocrinol Metab 1992;74 (6):1477-9.
11. Matsumoto S, Shingu C, Hidaka S, et al. Anesthetic manage- ment of a patient with hyperthyroidism due to hydatidiform mole. J Anesth 2009;23(4):594-6.
12. Erturk E, Bostan H, Geze S, Saracoglu S, Erciyes N, Eroglu A. Total intravenous anesthesia for evacuation of a hydatidi- form mole and termination of pregnancy in a patient with thy- rotoxicosis. Int J Obstet Anesth 2007;16 (4):363-6.
13. Solak M, Aktürk G. Spinal anesthesia in a patient with hyper- thyroidism due to hydatidiform mole. Anesth Analg 1993;77 (4): 851-2.