BES2005 Poster Presentations Clinical (51 abstracts)
Graves' disease and Struma Ovarii
RS Moisey 1 , DK Nagi 1 , J Andrew 1 , AJ Anathhanam 2 , U Raja 2 , D Ali 3 , WA Burr 4 & RC Jenkins 1
1Edna Coates Diabetes and Endocrinology Unit, Pinderfield's General Hospital, Wakefield, UK; 2Department of Pathology, Pinderfield's General Hospital, Wakefield, UK; 3Department of General Surgery, Pinderfield's General Hospital, Wakefield, UK; 4Postgraduate Dean, The Yorkshire Deanery, University of Leeds, Leeds, UK.
A 34-year-old woman was referred by her GP in 2000 with thyrotoxicosis (TSH undetectable, free T4 36.4 pica moles per litre, reference range 10-25). She had no ophthalmic symptoms or signs and no goitre. There was no family history of thyroid disease. Her thyroid peroxidase antibodies were undetectable but thyrotropin-binding inhibitory immunoglobulin was 30 (Reference range 0-15) confirming Graves' disease. Carbimazole was initiated but changed to propylthiouracil after a pregnancy was confirmed. She suffered rupture of membranes at twenty-six weeks and had an emergency caesarean section with loss of the foetus. At surgery a large right-sided ovarian cyst was noted. She had previously undergone a left oophorectomy 12 years ago for an ovarian teratoma. Serial ultrasounds of the right ovary confirmed the cyst to be persistent and, as she was contemplating a further pregnancy, she underwent a right ovarian cystectomy in June 2001. Histology and immunohistochemistry showed a teratoma with a predominance of thyroid tissue confirming struma ovarii. Following surgery her thyrotoxicosis persisted and she continued with propylthiouracil. She had a further, successful, pregnancy and during the third trimester her propylthiouracil was stopped with normal thyroid function. Post-partum her Graves disease relapsed and because of her young family she underwent a thyroidectomy. Histology showed changes consistent with thyrotoxicosis modified by treatment. Despite surgery she remained thyrotoxic and an Iodine 123 isotope scan showed residual thyroid tissue in the position of the thyroid. She now awaits treatment with radioactive iodine. Struma ovarii is a rare cause of thyrotoxicosis and there only a few case reports of struma ovarii in association with Graves' disease.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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