DIAGNOSTIC AND MANAGEMENT PROBLEMS OF HYPERTHYROIDISM IN A PATIENT WITH TESTICULAR SEMINOMA

Patients   with   thyroid   dysfunction   are   well   represented   in   the general   population. Hyperthyroidism can develop as a paraneoplastic syndrome in germ cell tumors. Testicular seminoma as a form of germ cell tumors, can express human chorionic gonadotropin (hCG). Beta-hCG strongly resembles TSH. A 26-year-old male with a history of cryptorchidism, came to Dr. Soetomo Hospital with the complaints of palpitation, diarrhea, weight loss, fatigue,  nervousness,  excessive  sweating,  and  heat intolerance.  He  also  complained  of enlarged breast and a palpable mass in lower abdomen for 4 months. From the TSH and FT4 examinations, patient's symptoms were in accordance with thyrotoxicosis. Anti-TPO and thyroid USG examination were within normal limits. Patient was treated with beta-blocker and thiamazole. Histopathology of abdominal mass showed a testicular seminoma. After surgery and chemoterapy, the clinical symptoms of hyperthyroidism gradually improved. Administration of beta-blocker and thiamazole was stopped in 4 months after surgery. Many of germ cell tumors in male are associated with cryptorchidism, half of them being testicular seminoma. Seminoma expresses hCG.  At  very high levels, hCG can stimulate the TSH receptors,  causing  hyperthyroidism  or  thyrotoxicosis.  TSH  and  FT4  measurement  were needed in patient with suspected hyperthyroidism. Anti-TPO test is performed to exclude autoimmune cause of thyroid disease. Symptomatic management of beta-hCG induced hyperthyroidism is not different from hyperthyroidism in general, namely administration of beta-blocker  and  anti-thyroid  drugs.  However,  the  definitive  treatments  are  surgery and chemotherapy. Hyperthyroidism in germ cell tumors almost all responds well to surgery and chemotherapy.