is hypothyroidism a cause of ovarian cysts?- this unusual ...large ovarian cysts without the need of...

Article ID: WMC001641 ISSN 2046-1690

Is Hypothyroidism a Cause of Ovarian Cysts?- ThisUnusual Case Depicts SoCorresponding Author:Prof. Rajiv R Mahendru,Consultant, Obs Gyn, MMIMSR, 134003 - India

Submitting Author:Prof. Rajiv R Mahendru,Consultant, Obs Gyn, MMIMSR, 134003 - India

Article ID: WMC001641

Article Type: Original Articles

Submitted on:01-Mar-2011, 02:56:39 PM GMT Published on: 07-Mar-2011, 05:52:57 PM GMT

Article URL: http://www.webmedcentral.com/article_view/1641

Subject Categories:OBSTETRICS AND GYNAECOLOGY

Keywords:Ovarian Cyst, Hypothyroidism, Prepubertal

How to cite the article:Mahendru RR, Mittal A , Gaba G . Is Hypothyroidism a Cause of Ovarian Cysts?- ThisUnusual Case Depicts So . WebmedCentral OBSTETRICS AND GYNAECOLOGY 2011;2(3):WMC001641

Source(s) of Funding:

MMET

Competing Interests:

No Competing Interests

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Is Hypothyroidism a Cause of Ovarian Cysts?- ThisUnusual Case Depicts SoAuthor(s): Mahendru RR, Mittal A , Gaba G

Abstract

Presented in this report is apparently the first case ofits kind in the medical literature where an 11 year oldprepubescent girl who had co-existent presence ofhypothyroidism and multiple large ovarian cysts notonly had remarkable improvement in her physicalappearance with conservative management withL-Thyroxine alone but also had disappearance of herlarge ovarian cysts without the need of any surgicalintervention, whatsoever.

Introduction

Hardly any data is available as to the association ofhypothyroidism and ovarian cysts. Till date, themechanism of cyst formation in ovaries in patients ofprimary hypothyroidism remains unclear.1

Case Report

Written consent was taken from the patient (along withher guardians) and the Departmental Ethical Committee approved this report. A case is presentedof a female child aged 11 years, who reported withcomplaints of increasing obesity and lack of propergrowth, lethargy, fatigue, lack of concentration instudies, with no history of menarche or precociouspuberty. She had had pain in the pelvic area for lastone week. Significant findings on General Physicalexamination were of stunted growth for her age withweak reflexes and marked obesity (weight 44.5Kilograms). Her per abdomen examination was normaland on per rectal examination, uterus wasapparentally of pre-pubertal size with bilateral cysticmasses of the size of a tennis ball. Routine laboratoryinvestigations were normal and Thyroid profile statusrevealed decreased T3 value of 0.25ng/ml and T4value of 1ng/dl with markedly raised TSH value of791.42IU/ml. Radiographs of the skull and chestwere normal On ultrasonography of thyroid and upperabdomen no abnormality was detected while that ofpelvis showed bilateral ovarian enlargement with multiloculated cysts measuring 8cm x 7cm x 7cm in rightovary and 7cm x 7cm x 7cm on the left side with

uterus being of average prepubertal dimensions(Figure-1). The patient was put on oral L-Thyroxine, 50mcg. On follow up, the patient started showing signs ofimprovement within a month as her weight startedreducing while pelvic ultrasonography revealedregression in the size of the ovarian cysts. After fivemonths of treatment, her weight was 28.0 kg, thyroidfunction tests within normal values and markedreduction in the size of the ovarian cysts (Figure-2)and near normal size of the ovaries at one year. Thispatient is presently on regular treatment and follow-up.

Discussion

Although pathophysiology remains unclear,association of multicystic ovarian disease withhypothyroidism has been described in literature2-4.Various mechanisms were postulated which includedaltered oestrogen metabolism, hypothalamo-pituitarydysfunction and deranged prolactin metabolism2.According to Anasti et al5 ovarian enlargement insevere hypothyroidism was probably due tostimulation of FSH receptors by unusually high TSHlevels proved to have a weak FSH like activity. Eversand Rolland3 confirmed that cross reaction of highTSH could produce FSH- and LH-like activity whichmight be responsible for the cyst formation in theovaries. Likely mechanism of ovarian hyperstimulationwith hypothyroidism in the present case appears to bemutation in FSH receptors that may further increasethe sensitivity of FSH receptors to the TSH asproposed by Vasseur et al6 and Smith et al7. Merchlineet al4 reported that in some cases there might behyper secretion of one or the other trophic hormonesby the pituitary in response to deficiency of one of theendocrine glands (as of thyroid hormone), thereby,stimulating gonadotrophin release and hence FSH andLH leading to symptoms of precocious puberty with orwithout enlargement of the pituitary gland in responseto an end organ deficiency. Both precocious pubertyand pituitary enlargement were not to be seen in thecase being discussed. With t reatment ofhypothyroidism alone, there was not only remarkablesymptomatic improvement but also normalization ofthyroid function tests and resolution of ovarian cystsas in the studies of Hansen et al2 and Yamashita et al8

and consequently no surgical intervention was



warranted as reported by Bassam and Ajlouni1 andMerchline et al4.

Conclusion

In a prepubescent female whenever large ovariancysts are detected, possibility of hypothyroidismshould be kept as the diagnosis of this entity is aguide for the conservative management by thyroidhormone replacement therapy as the ovarian cystsregress in size along with improvement in thesymptoms of the patient, thereby, avoidingunwarranted surgical intervention.

Conflicts of interest: authors declare that there areno conflicts of interest.

ACKNOWLEDGEMENTS : M.M. EDUCATIONALTRUST

References

1. Bassam T and Ajlouni K. A case of ovarianenlargement in severe primary hypothyroidism andreview of literature. Ann Saudi Med 2006; 26: 66-7.2. Hansen K, Tho S, Hanly M et al. Massive ovarianenlargement in primary hypothyroidism. Fertil Steril1997; 67: 169-71.3. Evers JL, Rolland R. Primary hypothyroidism andovarian activity: evidence for overlap in the synthesisof pituitary glycoproteins- a Case report. BJOG 1981;88: 195-202.4. Merchline M, Riddlesberger Jr.,Jerald PK, RichardWM. The association of juvenile hypothyroidism andcystic ovaries. Radiology 1981; 139: 77-80.5. Anasti JN, Flack MR, Froehlich J, Nelson LM,Nisula BC. A potential novel mechanism forprecocious puberty in juvenile hypothyroidism. J clinEndocrinol Metab 1995; 80: 276-9.6. Vasseur C, Rodien P, Beau I, Desroches A, GerardC, de Poncheville L, Chaplot S, et al. A chorionicgonadot rop in -sens i t i ve muta t ion in thefollicle-stimulating hormone receptor as a case offami l ia l gestat ional spontaneous ovar ianhyperstimulation syndrome. N Engl J Med. 2003; 349:753-9.7. Smith G, Olalunbosun O, Delbaere A, Pierson R,Vassart G, Coslagliola S. Ovarian hyperstimulationsyndrome due to a mutation in the follicle-stimulatinghormone receptor. N Engl J Med. 2003; 349: 760-6.8. Yamashita Y, Kawamura T, Fuzikawa R, MochizukiH, Okubo M and Arita K. Regression of both pituitaryand ovarian cysts after administration of thyroidhormone in a case of primary hypothyroidism. Internal

Medicine 2001; 40: 751-5.Figure-1.legend: ovarian cysts at the time ofpresentation Figure-2.Legend: marked reduction in the size ofovarian cysts with treatment



Illustrations

Illustration 1

Figure-1.Legend: ovarian cysts at the time of presentation



Illustration 2

Marked reduction in the size of ovarian cysts with treatment



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is hypothyroidism a cause of ovarian cysts?- this unusual ...large ovarian cysts without the need of...

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