Abstract
Background:
Juvenile primary hypothyroidism causing cystic ovaries and pseudoprecocious puberty (Van-Wyk–Grumbach syndrome) is well-documented in the medical literature. However, there are few reports of adult females with ovarian cysts due to uncontrolled primary hypothyroidism in this literature.
Case:
Herein is a case of huge bilateral ovarian cysts mimicking as malignant masses in a female who also had chronic uncontrolled hypothyroidism. This 25-year-old patient, married for 2.5 years, presented with pain in her abdomen and an inability to conceive. These problems were associated with early satiety, fullness after meals, heavy menstrual bleeding, becoming easily fatigued, and tiredness. She had what felt like a single huge abdominal mass that was not tense nor tender. Ultrasonography showed a large, solid, cystic, multiloculated, thick septated mass of 10.6 × 9.8 cm in the right adnexa and an enlarged left ovary. Magnetic resonance imaging showed a multiloculated, solid cystic mass of 10.6 × 8.4 × 8.3 cm with thick septations arising from the right ovary and another mass of 7.4 × 6.5 × 5.4 cm in the left ovary. Her thyroid-stimulating hormone level was >150 international units (IU)/mL and her cancer antigen (CA)–125 level was 235 IU/mL. Per endocrinology recommendations, she was given oral thyroxine (150 μg once per day) instead of undergoing surgical resection of the masses.
Results:
After 4 weeks of taking the thyroxine, clinical reduction in the size the masses and a decrease of her CA-125 level to 14 IU/mL were noted. Then, 1 month later, she developed right ovarian torsion, for which laparoscopy, followed by bilateral ovarian cystectomy, was performed. A histopathologic report showed no malignant changes in the tissue samples. Simultaneously, a workup for infertility showed that her serum anti-Müllerian hormone level was old. Ovum donation was advised, and the patient was referred to a higher-level medical center for further management.
Conclusions:
Failure to recognize hypothyroidism as an etiology of ovarian masses can lead to inadvertent surgical interventions.
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