Hyperthyroidism is a potentially life-threatening complication of GTD. The pathophysiology of trophoblast-induced hyperthyroidism has been well-elucidated, and it can be explained by the structural homology of hCG and TSH, excessive hCG levels secreted by trophoblast in GTD and the increased thyrotropic activity of hCG in GTD. Biochemical hyperthyroidism is more likely to be observed in CM compared to PM, which relates to the greater amount of hCG produced in CM.

The incidence and prevalence of hyperthyroidism is likely to be significantly affected by implementation and uptake of early antenatal screening. The increasing use of first trimester ultrasonography and serum hCG testing combined with early management has led to fewer women presenting with GTD late in gestation, thus lowering the frequency of characteristic GTD symptoms such as hyperthyroidism. The rates of hyperthyroidism in GTD may also serve as a marker for socioeconomic disparities between healthcare systems and healthcare resources. There is insufficient evidence to assess ethnicity as a risk factor for hyperthyroidism in GTD, although future studies should confirm this.

It is important to detect and manage hyperthyroidism as it can lead to significant morbidity and mortality. Most cases of hyperthyroidism in GTD can be effectively controlled by anti-thyroid medications, and plasmaphoresis may represent an alternative therapeutic option in patient’s refractory to medical treatment or patients requiring urgent surgery. Surgical evacuation of the uterus remains the only definitive treatment option for hyperthyroidism in GTD. Most patients will be euthyroid and not require further antithyroid treatment after surgery. Prior to surgery, however, a comprehensive anaesthetic work-up for hyperthyroidism is critical. Hyperthyroidism is an important perioperative consideration in patients with GTD, and haemodynamic status and thyroid function should be optimised prior to surgery, in order to prevent complications. Careful planning of perioperative anaesthetic management is also vital [41].

The paucity of observational studies on this topic meant that a quantitative exploration (meta-analysis) of our outcomes could not be performed. There was also considerable heterogeneity between the studies, particularly in the case definition for GTD, diagnostic criteria for hyperthyroidism and diversity of patient populations (e.g. timing of presentation, pre-existing comorbidities and type of GTD). The retrospective nature of several observational studies also makes them susceptible to information bias, as study variables and outcomes could be misclassified. In addition, it is difficult to verify the accuracy and completeness of recorded information. For example, patients with missing information relating to biochemical markers of thyroid function may have been excluded, leading to selection bias.

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