Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.

BACKGROUND: Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Patients with persistent disease require treatment with chemotherapy. For the vast majority, prognosis is excellent. Occasionally, GTD is complicated by hyperthyroidism, which may require treatment. This is thought to occur due to molecular mimicry between human chorionic gonadotrophin (HCG) and thyroid-stimulating hormone (TSH), and hence cross-reactivity with the TSH receptor. Hyperthyroidism usually resolves as the GTD is successfully treated and correspondingly HCG levels normalise. METHODS: This paper reviews cases of GTD treated over a 5-year period at one of the three UK centres and identifies the prevalence of hyperthyroidism in this population. Four cases with clinical hyperthyroidism are discussed. RESULTS: On review of the 196 patients with gestational trophoblastic neoplasia treated with chemotherapy in Sheffield since 2005, 14 (7%) had biochemical hyperthyroidism. Of these, four had evidence of clinical hyperthyroidism. CONCLUSION: Concomitant biochemical thyroid disease in patients with GTD is relatively common, and measurement of thyroid function in patients with persistent GTD is, therefore, important. The development of hyperthyroidism is largely influenced by the level of HCG and disease burden, and usually settles with treatment of the persistent GTD. However, rarely the thyroid stimulation can have potentially life-threatening consequences.

Advances in management of bone disease in breast cancer.

Breast cancer is the commonest malignancy diagnosed in women. Although there have been huge advances in treatment in recent years leading to excellent outlooks for many women, a significant number of patients are developing bone complications. This is often due to metastatic bone disease, which occurs in approximately 70% of women with advanced breast cancer. Additionally, accelerated bone loss and associated complications such as fractures may be a consequence of adjuvant treatment. Whatever the cause, cancer-induced bone disease can have potentially devastating clinical consequences for the patient, and results in a considerable economic burden to the health care provider. This review addresses the causes and sequelae of bone disease in both early and advanced breast cancer. The evidence for preserving bone health, both with traditional treatments such as bisphosphonates and newer agents, including antibody therapy is reviewed, with recommendations for current practice. Finally, we discuss the emerging potential role of bone-targeting therapies in preventing the development of metastatic disease.