A 24 yr old unmarried girl with H/O hyperthyroidism for last 12 year now presented with non-specific lower abdominal mild pain. USG and CT abd.suggestive of B/L complex ovarian mass.NO other finding in abdomen NO ascies present.
CA-125is 151. B HCG, AFP, LDH are normal.
What are the chances of some abnormal stimulation of ovaries and presenting with mass?
Is there is any link between TSH and LH , FSH STIMULATION? What are the method to differentiate between malignant ovarian tumor and struma ovarii?
There are many details to be filled in. It would be nice to know about her treatment, if any, for 12 years, and her thyroid exam, current thyroid tests, anti-thyroid antibodies, Anti-TSH-receptor antibodies, eye signs, and family history. But the most important test will be an 131-I scan to see if there is functioning thyroid tissue in the mass, and whether the thyroid in the neck is functioning, or suppressed. If no uptake, then it rules out an ovarian teratoma as the source of hyperthyroidism.. You could have only a ovarian mass producing excess T4, or even both the mass and the thyroid contributing to the hyperthyroidism if Graves disease is present. It seems likely that she will end up with surgery for the mass in any instance.
Leslie De Groot, MD