Hyperthyroidism associated with struma ovarii – a case report and review of literature

Abstract

Background

Hyperthyroidism is a state characterized by elevated serum level of thyroid hormones: thyroxine (T4) and triiodothyronine (T3). This is mainly related to the condition and functioning of the thyroid gland. In 60–80% of cases elevation of these hormones are caused by Grave’s disease. Thyrotoxicosis is an extreme presentation of hyperthyroidism which can, in rare cases, be caused by excessive synthesis of thyroxine by tumor cells. Struma ovarii is a rare ovarian teratoma composed of thyroid tissue in more than 50%.

Objective and method

To present a case of a 30-year-old female patient with a past history of Grave’s disease treated by strumectomy 7 years prior; now presenting for the assessment of secondary amenorrhea. Pelvic ultrasound revealed bilateral solid tumors on the left and right ovary, respectively measuring 5 cm and 6 cm in diameter. Her clinical presentation was suggestive of overt hyperthyroidism, and she presented with a significantly elevated CA-125 (152.7 U/mL).

Results

The patient subsequently underwent a bilateral oophorectomy in which both masses were excised and histopathological examination confirmed teratoma maturum cysticum. Struma ovarii was noted as a component of the left ovary teratoma.

Conclusion

Establishing a proper diagnosis of hyperthyroidism and elucidating its origin is often challenging. Struma ovarii is a rare cause of hyperthyroidism but should always be considered in case of treatment resistant hyperthyroidism. This case-report lends itself as an example of the value in maintaining gynecological-endocrinological knowledge in the setting if clinical gynecology.

甲状腺功能亢进症合并卵巢甲状腺瘤一例病例报告并文献复习 摘要

背景：甲状腺功能亢进症是一种以血清甲状腺激素：甲状腺素 (T4) 和三碘甲腺原氨酸 (T3)升高为特征的状态。这主要与甲状腺的状况和功能有关。在 60-80% 的情况下, 这些激素的升高是由Grave’s病（毒性弥漫性甲状腺肿）引起的。 甲状腺毒症是甲状腺功能亢进的一种极端表现, 在极少数情况下, 可由肿瘤细胞过度合成甲状腺素引起。卵巢甲状腺瘤是一种罕见的卵巢畸胎瘤, 其甲状腺组织占 50% 以上。

目的和方法：介绍一名30岁女性患者7年前接受甲状腺切除术治疗的Grave’s病病史的病例：现在评估已经为继发性闭经。盆腔超声检查显示左卵巢和右卵巢有实体肿瘤, 直径分别为5厘米和6厘米。患者的临床表现提示明显的甲状腺机能亢进, 伴随CA-125升高（152.7 U/mL）。

结果：患者随后接受了双侧卵巢切除术, 切除两个肿块, 组织病理学检查确认成熟畸胎瘤。卵巢甲状腺瘤被认为是左卵巢畸形瘤的组成部分。

结论：建立甲状腺机能亢进的正确诊断并阐明其起源往往具有挑战性。卵巢甲状腺瘤是甲状腺机能亢进的罕见原因, 但在耐药性甲状腺机能亢进的情况下应该考虑此病。本病例报告以临床妇科为例, 说明了在临床工作中妇科内分泌学知识的价值。

KEYWORDS:

• Hyperthyroidism
• Graves disease
• struma ovarii
• teratoma

Disclosure statement

No potential conflict of interest was reported by the author(s).