HYPERTHYROIDISM DUE TO COEXISTENCE OF GRAVES' DISEASE AND STRUMA OVARII.
Chiofalo, Maria G. MD 1; Misso, Claudia MD 1; Insabato, Luigi MD 3; Lastoria, Secondo MD 2; Pezzullo, Luciano MD 1
[Report]
Endocrine Practice.
13(3):274-276, May/June 2007.
(Format: HTML, PDF)
Objective: To report an unusual case of persistent thyrotoxicosis after treatment of Graves' disease, because of coexistence of struma ovarii.
Methods: We report the clinical history, imaging studies, laboratory and pathologic data, and treatment in a patient with persistent hyperthyroidism after surgical treatment of Graves' disease. In addition, we discuss some aspects of the pathogenesis of hyperthyroidism due to functioning struma ovarii.
Results: A 42-year-old woman underwent near-total thyroidectomy for treatment of Graves' disease. Postoperatively, hyperthyroidism was still present.
Methimazole was administered again, and performance of a 131I whole-body scan demonstrated a focus of intense uptake in the pelvis. Pelvic ultrasonography revealed a mass (11 by 8 by 7.1 cm) arising from the right ovary, with both solid and cystic components. Abdominal surgical exploration was performed, and the final histologic diagnosis was struma ovarii. The symptoms of hyperthyroidism diminished, and 3 weeks postoperatively, the thyroid hormone levels were in the hypothyroid range.
Conclusion: In patients with refractory hyperthyroidism after thyroid surgical treatment, radioiodine scanning should be performed to diagnose or exclude the functioning profile of ovarian masses.
(C) 2007 Allen Press