Abstract：
BACKGROUND: Paraneoplastic hyperthyroidism (PH) has been reported in patients with testicular germ cell tumors (GCTs), sporadically. This disorder is caused by extremely elevated serum levels of beta-human chorionic gonadotropin (bHCG). To date, little is known about the prevalence of PH, and its clinical features are poorly understood. The aim of the present study was to analyze the relative frequency and clinical features of PH in GCTs and evaluate their effects on therapeutic outcomes.
METHODS: A cohort of 438 patients treated for testicular GCT from 2017 to 2023 was retrospectively analyzed for histology, age, clinical stage, and presence of PH. The clinical features of the patients with PH were evaluated descriptively. The relative frequency of PH was compared among the subgroups using descriptive statistical methods.
RESULTS: Three patients with PH were identified; all had clinical symptoms of hyperthyroidism, suppressed serum levels of thyroid-stimulating hormone (TSH), and increased levels of tri-iodothyronin (fT3). All the patients had advanced, metastasized, and non-seminomatous GCTs. Serum bHCG levels ranged from 225,00 U/L to 1,520,000 U/L. The prevalence of PH was 0.7% in the entire GCT population and 60% in those with very high bHCG serum levels. All the patients received standard cisplatin-based chemotherapy along with thyrostatic treatment. The clinical symptoms of the hyperthyroidism rapidly disappeared. TSH levels normalized with decreasing bHCG levels. The PH treatment did not affect the therapeutic outcomes of the patients.
CONCLUSIONS: PH may occur in 0.7% of all patients with GCT but may be present in up to 60% of patients with very high levels of bHCG. Measuring serum levels of TSH and fT3 should be performed in addition to routine diagnostic measures in all patients with poor prognosis GCTs. Thyrostatic medication is recommended for patients with the clinical symptoms of hyperthyroidism. Early recognition of hyperthyroidism and prompt intervention will reduce comorbidity and help optimize therapeutic outcomes.
METHODS: A cohort of 438 patients treated for testicular GCT from 2017 to 2023 was retrospectively analyzed for histology, age, clinical stage, and presence of PH. The clinical features of the patients with PH were evaluated descriptively. The relative frequency of PH was compared among the subgroups using descriptive statistical methods.
RESULTS: Three patients with PH were identified; all had clinical symptoms of hyperthyroidism, suppressed serum levels of thyroid-stimulating hormone (TSH), and increased levels of tri-iodothyronin (fT3). All the patients had advanced, metastasized, and non-seminomatous GCTs. Serum bHCG levels ranged from 225,00 U/L to 1,520,000 U/L. The prevalence of PH was 0.7% in the entire GCT population and 60% in those with very high bHCG serum levels. All the patients received standard cisplatin-based chemotherapy along with thyrostatic treatment. The clinical symptoms of the hyperthyroidism rapidly disappeared. TSH levels normalized with decreasing bHCG levels. The PH treatment did not affect the therapeutic outcomes of the patients.
CONCLUSIONS: PH may occur in 0.7% of all patients with GCT but may be present in up to 60% of patients with very high levels of bHCG. Measuring serum levels of TSH and fT3 should be performed in addition to routine diagnostic measures in all patients with poor prognosis GCTs. Thyrostatic medication is recommended for patients with the clinical symptoms of hyperthyroidism. Early recognition of hyperthyroidism and prompt intervention will reduce comorbidity and help optimize therapeutic outcomes.
摘要：
介绍副肿瘤性甲状腺功能亢进（PH）已经报道了睾丸生殖细胞肿瘤（GCTs）的患者，零星地。这种疾病是由β-人绒毛膜促性腺激素（bHCG）的血清水平极度升高引起的。迄今为止,对PH的患病率知之甚少，对其临床特征了解甚少。本研究的目的是分析GCT中PH的相对频率和临床特征，并评估其对治疗结果的影响。方法回顾性分析2017年至2023年收治的438例睾丸GCT患者的组织学特点,年龄,临床分期,和PH的存在。对PH患者的临床特征进行描述性评价。使用描述性统计方法比较亚组之间PH的相对频率。结果3例PH患者均有甲状腺功能亢进的临床症状,抑制血清促甲状腺激素（TSH）水平，和增加的三碘甲状腺激素（fT3）的水平。所有的病人都是晚期,转移，和非精原细胞瘤（GCT）。血清bHCG水平范围为225,00U/l至1,520,000U/l。在整个GCT人群中，PH的患病率为0.7％，在bHCG血清水平很高的人群中为60％。所有患者均接受标准的顺铂化疗和甲状腺治疗。甲亢的临床症状迅速消失。促甲状腺激素（TSH）水平随着bHCG水平的降低而正常化。PH治疗不影响患者的治疗结果。结论在所有GCT患者中,有0,7%的患者可发生PH,但可能存在于高达60%的bHCG水平非常高的患者中。除常规诊断措施外，还应测量所有预后不良的GCTs患者的血清TSH和fT3水平。对于有甲状腺功能亢进临床症状的患者，建议使用促炎药物。甲状腺功能亢进的早期识别和及时干预将减少合并症并有助于优化治疗结果。
