DOI: 10.14260/jemds/2014/3106 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 31/July 31, 2014 Page 8682 H. MOLE WITH HYPERTHYROIDISM: DILEMMA FOR EMERGENCY SURGERY Nidhi Arun 1 , Arvind Kumar 2 , Sangeeta Pankaj 3 , K. H. Raghwendra 4 , Vijayanand Choudhary 5 HOW TO CITE THIS ARTICLE: Nidhi Arun, Arvind Kumar, Sangeeta Pankaj, K. H. Raghwendra, Vijayanand Choudhary. “H. Mole with Hyperthyroidism: Dilemma for Emergency Surgery”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 31, July 31; Page: 8682-8685, DOI: 10.14260/jemds/2014/3106 ABSTRACT: H. mole can cause severe gestational hyperthyroidism, as molecular variant of human chorionic gonadotropin found in molar pregnancies have increased thyrotropic potency. High index of suspicion for hyperthyroidism should be kept in mind for the patients with GTD. Early diagnosis, effective management and preparedness to anticipate and manage perioperative complications before posting the patient for any surgical procedure avoid complications. We describe a case report of successful anesthetic management of young female with complete H. mole with incidentally diagnosed hyperthyroidism, posted for emergency D&E. KEYWORDS: H. Mole, Hyperthyroidism, emergency surgery. KEY MESSAGES: All patients with GTD should be screened for hyperthyroidism by history, clinical examination and laboratory investigations beforehand. In emergency scenario, patients with biochemical hyperthyroidism without any sign and symptom of thyrotoxicosis may be taken up for surgery with preparedness and back up facility. INTRODUCTION: Gestational Trophoblastic Disease (GTD) encompasses a spectrum of proliferative abnormalities of trophoblasts associated with pregnancy. One of the histological types of GTD is Hydatidiform mole (H. mole). H. mole is an abnormal condition of the placenta, where there is partly degenerative and partly proliferative changes in the young chorionic villi, resulting in formation of clusters of small cysts of varying size. It is best regarded as a benign neoplasia of the chorion with malignant potential. The incidence of molar pregnancies in India is about 1 in 400. 1 It predominantly affects younger women and presents with vaginal bleeding, most of the time. 2 Hyperthyroidism is a rare but known complication of GTD, with highest incidence in patients of complete mole. There are only few case reports in literature of this association 3 . When it is present, it can be severe and potentially life threatening. We describe a case report of successful anesthetic management of a young female with complete mole and hyperthyroidism, posted for dilatation and evacuation (D&E) of uterine cavity. CASE HISTORY: 19 years old female primigravida, weighing 48kgs visited emergency department of our institute with complaints of 4 month amenorrhoea, lower abdominal pain and active vaginal bleeding. On examination she was anxious, pale, her heart rate (HR) was 112/min and blood pressure (BP) was 100/70 mm of Hg. On per abdomen examination her uterus was enlarged and palpable. Her urine pregnancy test was positive and serum β human chorionic gonadotropin (hCG) level was 2,50,000 mIU/ml. Urgent bed side ultrasonography (USG) showed distended uterine cavity, which was filled with echogenic soft tissue mass that had small cystic component. This finding was most compatible with complete molar pregnancy. High index of suspicion of associated hyperthyroidism was kept in mind and thyroid profile was investigated. Her T3 = 1.85ng/dl, T4 = 29 μg/dl and TSH = 0.04 μIU/ml.