Acute Multiple Deep Venous Thrombosis (DVTs) As a Probable Adverse Event of the Use of Human Chorionic Gonadotropin (HCG) for Weight Loss
Authors: Parikh H. , Thomas Lisa , English R. , Raguckas C , Shi Qi 
Published: October 2019

Abstract
Obesity is a growing issue in today's society. Worldwide prevalence of obesity is about 37% in men and 38% in women in. Risk factors include genetic predisposition, stress, adverse drugs reactions, life stage (e.g., pregnancy or menopause), sedentary life style, etc. Obesity is associated with increased risk of cardiovascular disease, deep venous thrombosis, type 2 diabetes mellitus, hypertension, and osteoarthritis. Diet and exercise are primary strategies for losing weight. In addition, Orlistat, Lorcaserin, Qsymia, liposuction, and bariatric surgery are medical modalities to aid in weight loss. Weight loss due to HCG consumption is claimed to redistribute body fat from the hips, thighs, and stomach without unwanted effects such as hunger. A literature search revealed that no studies have examined the safety outcomes of HCG consumption as a weight loss aid. Our case emphasizes the adverse effect of the use of HCG as a dieting modailty.
Case Report
A 64 years old Caucasian female with history of hypertension, hypothyroidism, obesity and depression presented with progressive left lower extremity swelling for 3 months. She denied a history of DVT, recent surgery, cancer, or family history of thrombophilia. Her social history was negative for tobacco. The patient reported that she had four HCG injections in anticipation of losing weight three months ago. Physical examination: BMI: 35 kg/m2, left calf circumference was 44 cm and right calf circumference was 39 cm. Venous Doppler ultrasound showed acute DVT involving right probably popliteal, right posterior tibial, left common femoral, profunda femoris, proximal femoral, popliteal, posterior tibial and peroneal veins. Hypercoagulable test data showed were in normal negative. She was admitted to the hospital and anticoagulation therapy was started with therapeutic enoxaparin at 1mg/kg subcutaneously twice daily and 10mg warfarin orally once daily. When INR data was therapeutic range, enoxaparin was discontinued
The patient was discharged from the hospital on warfarin therapy. She was advised to discontinue HCG injections.
Discussion & Literature review
HCG, human chorionic gonadotropin, is a hormone produced during pregnancy. As a prescription medication, HCG is used mainly to treat fertility issues. HCG injections and oral/sublingual diet drops are advertised to assist with weight loss. However, clinical trials fail to support this claim. A meta-analysis was conducted to assess if there is scientific basis for the use of HCG in the treatment of obesity. This study included review of eight randomized trials and 16 cohort studies evaluation. Simeons diet was defined as a fat-free diet consisting of 500 kcal/day plus HCG, 125 units. Only one study showed an association between the Simeons diet with HCG and weight loss. Twelve studies reported that the weight-loss with the use of HCG was no greater than with the use of a placebo or with the use of a diet only. It was concluded that there is no scientific evidence that HCG is effective in the treatment of obesity; it does not bring about weight loss or fat redistribution, nor does it reduce hunger or induce a feeling of well-being. Previous studies have also been reported side effects with HCG include fatigue, irritability, restlessness, depression, fluid buildup (edema), swelling of the breasts in boys and men (gynecomastia), and thromboembolism. The theorized mechanism of thromboembolism, secondary to HCG use has been associated with the hormone's ability to hyperstimulate the ovaries which can lead to a surge of hormones and vasoactive substances, increase in vascular permeability, and hemoconcentration. These can ultimately predispose to a hypercoagulable state.

Disclosures
No relevant conflicts of interest to declare.