The role of hysterectomy in managing large hydatidiform moles with subclinical hypothyroidism and very early onset of preeclampsia: A case report

Hydatidiform mole is one of the gestational trophoblast diseases (GTD) originating from the placenta, which is characterized by excessive growth of the trophoblast villi. The incidence was 1-2 cases in 1000 pregnancies. The hCG levels and thyroid function can determine the management and prognosis of hydatidiform mole. This case report review aims to present a patient with Hydatidiform Mole with hypothyroidism and very early onset of preeclampsia. A 39-year-old lady reported having an enlarged stomach and not having menstrued for the previous five months. Based on examination, it was indicated that she had high blood pressure of 183/104 mmHg, and the ultrasound results showed a honeycomb appearance. Laboratory results showed b-hCG 405,000 mIU/mL, TSH 7.64 mIU/L, T3 0.85 ng/dL, 0.91 ng/dL, Albumine 2.23 g/dL, and Proteinuria +4. The patient then performed laparotomy hysterectomy and bilateral salpingectomy. The patient received medical treatment for her hypertension, hypoalbuminemia, and hypothyroidism prior to surgical intervention. The post-operative evaluation was carried out by observing thyroid levels and b-hCG levels, where normal thyroid level was achieved, and b-hCG level was normal on the 63rd post-operative day 2.3 mIU/mL.  Finding earlier hydatidiform mole led to the easier treatment. The hydatidiform mole should be treated medically prior surgical intervention, for example, preeclampsia. Hysterectomy is best therapeutic for patients with larger uterine size and who have finished childbearing. b-hCG after surgical intervention has to be observed to prevent GTN (Gestational Trophoblastic Neoplasia).