Teale Elizabeth, Gouldesbrough David R, Peacey Steven R
Departments of Diabetes and Endocrinology, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom.
Thyroid. 2006 Aug;16(8):791-3. doi: 10.1089/thy.2006.16.791.
Struma ovarii is a rare cause of hyperthyroidism and particularly rare in patients with coexisting Graves' disease. We describe a 28-year-old female who presented with symptoms and signs of hyperthyroidism (free thyroxine [FT(4)] 39 pmol/L, thyrotropin [TSH] < 0.05 mU/L) and associated ophthalmopathy, consistent with Graves' disease. The patient relapsed twice: once after initial successful management with carbimazole and subsequently after subtotal thyroidectomy. Radioisotope scanning showed focal uptake bilaterally in the neck and believing this was the source of thyroid hormone excess, carbimazole was restarted. A left ovarian mass was found on ultrasound during the investigation of unrelated nephrotic syndrome resulting from focal segmental glomerulosclerosis. A 555-g struma ovarii was removed surgically. Hypothyroidism developed postoperatively (FT(4) 9.7 pmol/L, TSH 36 mU/L). Circulating TSH receptor stimulating antibodies were positive and immunohistochemical studies confirm the presence of TSH receptors on the struma ovarii. The demonstration of TSH receptors on the struma ovarii increases previous speculation that struma ovarii growth and function may be augmented by the circulating TSH receptor stimulating antibodies of Graves' disease.
卵巢甲状腺肿是甲状腺功能亢进症的罕见病因，在合并格雷夫斯病的患者中尤为罕见。我们描述了一名28岁女性，她出现了甲状腺功能亢进的症状和体征（游离甲状腺素[FT(4)] 39 pmol/L，促甲状腺激素[TSH]<0.05 mU/L）以及相关的眼病，符合格雷夫斯病。该患者复发了两次：一次是在最初使用卡比马唑成功治疗后，另一次是在甲状腺次全切除术后。放射性同位素扫描显示颈部双侧有局灶性摄取，由于认为这是甲状腺激素过量的来源，于是重新开始使用卡比马唑。在对因局灶节段性肾小球硬化导致的无关肾病综合征进行检查期间，超声检查发现左侧卵巢有一个肿块。手术切除了一个555克的卵巢甲状腺肿。术后出现了甲状腺功能减退（FT(4) 9.7 pmol/L，TSH 36 mU/L）。循环中的促甲状腺激素受体刺激抗体呈阳性，免疫组织化学研究证实卵巢甲状腺肿上存在促甲状腺激素受体。卵巢甲状腺肿上促甲状腺激素受体的证实增加了之前的推测，即卵巢甲状腺肿的生长和功能可能因格雷夫斯病循环中的促甲状腺激素受体刺激抗体而增强。
