Endocrine Abstracts

Introduction: The triad of primary hypothyroidism, precocious puberty and delayed bone age in children with cystic ovarian enlargement constitutes the syndrome of van wyk grumbach. Commonly reported as a rare complication of hypothyroidism in children, there are only a few case reports in adult population. Herewith, we are reporting the case of a 22-year-old hypothyroid lady, who presented with bilateral ovarian cysts. Considering hypothyroidism, a high risk for surgery, thyroxine dose was optimised; to see that the cysts started shrinking in size and eventually disappeared.

Case: 22-year-old lady, with no known comorbidities, presented with complaints of lower abdominal pain for 1 week. On examination, there was a mass felt in the left iliac region, reaching up-to the umbilicus. It was non-tender and non-ballotable with cystic consistency. USG Abdomen showed bulky uterus with multiseptated cystic lesions in the adnexa, with no significant vascularity or solid components. It was succeeded with an MRI abdomen, which confirmed the same. There was age lobulated septate thin-walled cystic lesion in the right ovary measuring 13.5 x 8.1 x 6.9 cm, and a lesion in the left ovary measuring 7.3 x 6.4 x 6.5 cm, with probable haemorrhagic content. CA-125 was also found to be elevated. Though non-specific, with multicystic ovarian lesions and elevated CA-125 in a young lady, the possibility of an ovarian neoplasm was thought of and she was planned for laparoscopic ovarian cystectomy. On pre-operative evaluation, TSH was found to be significantly elevated – 65.42 mcIU/ml. Endocrinology consultation was sought and she was started on Thyroxine supplementation. Surgery was post-ponded in view of peri-operative morbidity, and she was discharged. She was followed-up and thyroxine dose was optimised in subsequent visits. Repeat imaging showed complete resolution of mass after 6 months.

Conclusion: Multiple ovarian cysts in a young lady can be indicative of an infection or malignancy, but at times can be due to benign systemic conditions like hypothyroidism. Prompt treatment of hypothyroidism made the ovarian cysts to disappear, which otherwise would have resulted in a major futile surgery.

References: 1. Egodawaththe NS, Seneviratne SN, Gunasekara S, Amarasekara SM, Weerasekara K. Van Wyk-Grumbach syndrome and oligosyndactyly in a 6-year-old girl: a case report. Journal of Medical Case Reports. 2020 Dec;14(1):1-7.

2. Kubota K, Itho M, Kishi H, Igarashi S, Minegishi T. Primary hypothyroidism presenting as multiple ovarian cysts in an adult woman: a case report. Gynecological Endocrinology. 2008 Jan 1;24(10):586-9.