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Cited by 154Thyroid Disorders and TreatmentsGestational Trophoblastic Disease StudiesGrowth Hormone and Insulin-like Growth Factors

Human Chorionic Gonadotropin and the Thyroid: Hyperemesis Gravidarum and Trophoblastic Tumors

HERSHMAN, JEROME M.·1999·Thyroid
DOI 10.1089/thy.1999.9.653
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Abstract

There is abundant evidence that human chorionic gonadotropin (hCG) is a weak thyrotropin (TSH) agonist. In FRTL-5 rat thyroid cells, hCG increases cyclic adenosine monophosphate (cAMP), iodide transport, and cell growth. hCG has thyroid-stimulating activity in bioassays in mice and in clinical studies in man. In cultured cells transfected with the human TSH receptor, hCG increases generation of cAMP. Molecular variants of hCG with increased thyrotropic potency include basic molecules with reduced sialic acid content, truncated molecules lacking the C-terminal tail, or molecules in which the 47-48 peptide bond in the beta-subunit loop is nicked. In normal pregnancy, when hCG levels are highest at 10 to 12 weeks gestation, there is suppression of serum TSH levels, presumably due to slight increases in free thyroxine (T4) concentration. In twin pregnancies, hCG levels tend to be higher and suppressed TSH levels are more frequent. Hyperemesis gravidarum, defined as severe vomiting in early pregnancy that causes 5% weight loss and ketonuria, is usually associated with increased hCG concentration. A high proportion of patients with hyperemesis gravidarum, about one-third to two-thirds in different series, have evidence of increased thyroid function. Only a small proportion of these patients have clinical hyperthyroidism, termed gestational thyrotoxicosis. These patients probably secrete a variant of hCG with increased thyroid-stimulating activity. Trophoblastic tumors, hydatidiform mole, and choriocarcinoma often cause hyperthyroidism because they secrete very large amounts of hCG. When the serum hCG exceeds about 200 IU/mL, hyperthyroidism is likely to be found. There is a correlation between the biochemical severity of hyperthyroidism and the serum hCG in these patients. Removal of the mole or effective chemotherapy of the choriocarcinoma cures the hyperthyroidism. In conclusion, hCG has thyroid-stimulating activity that influences thyroid function early in pregnancy when hCG levels are high. Excessive hCG secretion may cause hyperthyroidism in patients with hyperemesis gravidarum or trophoblastic tumors.

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Authors
HERSHMAN, J. M.
Affiliations
University of California, Los Angeles (US)
Corresponding author
HERSHMAN, JEROME M.
Venue
Thyroid
Publisher
SAGE Publications
Published
1999-07
Volume
9
Issue
7
Pages
653-657
ISSN
  • 1050-7256 (ISSN-L)
  • 1557-9077
DOI
10.1089/thy.1999.9.653
OpenAlex
W2023553902
Cited by
154
References
37
Citations by year
2026: 4 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 3 · 2021: 11 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 8 · 2015: 7 · 2014: 8 · 2013: 8 · 2012: 6
FWCI
2.48
Type
journal article
Language
en
Open access
closed
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Thyroid (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Gestational Trophoblastic Disease Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
Keywords
human chorionic gonadotropin, hyperemesis gravidarum, gestational thyrotoxicosis, trophoblastic neoplasia, hydatidiform mole, choriocarcinoma, TSH receptor, cAMP signaling, iodide transport, sialic acid, C-terminal tail, TSH suppression, thyroid function in pregnancy, twin pregnancy
MeSH terms
Animals, Cell Line, Choriocarcinoma, Female, Chorionic Gonadotropin, Humans, Hydatidiform Mole, Hyperemesis Gravidarum, Hyperthyroidism, Pregnancy, Thyroid Gland, Trophoblastic Neoplasms, Uterine Neoplasms, Mice, Rats

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