THYROID-STIMULATION BY PLACENTAL FACTORS

There is now convincing evidence that the human placenta produces factors which have some role in regulating maternal thyroid function during normal pregnancy and are capable of inducing overt hyperthyroidism in some pregnant women and in patients with trophoblastic tumors. As far as the biochemical nature of these placental thyroid stimulators is concerned, a bulk of evidence indicates that hCG, which is abundant in the blood of pregnant women and patients with trophoblastic diseases and shares some structural similarities with human TSH, is the putative thyroid-stimulating factor. However, it is disturbing that most in vitro studies have failed to prove that hCG is truly capable of stimulating the human thyroid. Therefore, factors other than hCG have also to be considered, particularly some molecular variant forms of hCG with enhanced thyrotropic activity. Both the existence of tumor-associated hCG variants in patients with trophoblastic diseases and their ability to stimulate thyroid hormone release in human thyroid tissue have been demonstrated. To complicate things further, other variants of hCG have been identified and purified from pregnancy urine that have a thyroid inhibitory effect in human thyroid membranes. The variant forms of hCG have been shown to differ from the native hormone mainly in the carbohydrate moiety, with the more acidic, more glycosylated variants being the ones capable of stimulating the human thyroid and the more alkaline sialic acidic deficient variants, on the other hand, being potent thyroid inhibitors. Future studies should reveal if the different thyroid stimulators and thyroid inhibitors may possibly interact with specific regions of the human TSH receptor that confer their respective functional activities. An interaction of different hCG variants with stimulatory or inhibitory receptor domains could explain the complex nature of the thyroid regulatory actions of hCG and its variant forms.