Hyperthyroidism due to coexistence of Graves' disease and Struma ovarii

Endocr Pract. May-Jun 2007;13(3):274-6. doi: 10.4158/EP.13.3.274.

Abstract

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. Post-operatively, 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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Graves Disease / complications*
  • Graves Disease / therapy
  • Gynecologic Surgical Procedures
  • Humans
  • Ovarian Neoplasms / complications*
  • Ovarian Neoplasms / surgery
  • Struma Ovarii / complications*
  • Struma Ovarii / surgery
  • Thyroidectomy
  • Thyrotoxicosis / etiology*
  • Thyrotoxicosis / therapy