Chiofalo Maria G, Misso Claudia, Insabato Luigi, Lastoria Secondo, Pezzullo Luciano
Department of Surgical Oncology, National Cancer Institute, Naples, Italy.
Endocr Pract. 2007 May-Jun;13(3):274-6. doi: 10.4158/EP.13.3.274.
To report an unusual case of persistent thyrotoxicosis after treatment of Graves' disease, because of coexistence of struma ovarii.
We report the clinical history, imaging studies, laboratory and pathologic data, and treatment in a patient with persistent hyperthyroidism after surgical treatment of Graves' disease. In addition, we discuss some aspects of the pathogenesis of hyperthyroidism due to functioning struma ovarii.
A 42-year-old woman underwent near-total thyroidectomy for treatment of Graves' disease. Post-operatively, hyperthyroidism was still present. Methimazole was administered again, and performance of a 131I whole-body scan demonstrated a focus of intense uptake in the pelvis. Pelvic ultrasonography revealed a mass (11 by 8 by 7.1 cm) arising from the right ovary, with both solid and cystic components. Abdominal surgical exploration was performed, and the final histologic diagnosis was struma ovarii. The symptoms of hyperthyroidism diminished, and 3 weeks postoperatively, the thyroid hormone levels were in the hypothyroid range.
In patients with refractory hyperthyroidism after thyroid surgical treatment, radioiodine scanning should be performed to diagnose or exclude the functioning profile of ovarian masses.
报告1例格雷夫斯病（Graves' disease）治疗后出现持续性甲状腺毒症的罕见病例，病因是存在卵巢甲状腺肿。
我们报告1例格雷夫斯病手术治疗后出现持续性甲状腺功能亢进患者的临床病史、影像学检查、实验室及病理数据和治疗情况。此外，我们还讨论了功能性卵巢甲状腺肿导致甲状腺功能亢进的发病机制的一些方面。
一名42岁女性因格雷夫斯病接受了近全甲状腺切除术。术后，甲状腺功能亢进仍然存在。再次给予甲巯咪唑治疗，131I全身扫描显示盆腔有一个摄取强烈的病灶。盆腔超声检查发现右侧卵巢有一个肿块（11×8×7.1 cm），有实性和囊性成分。进行了腹部手术探查，最终组织学诊断为卵巢甲状腺肿。甲状腺功能亢进症状减轻，术后3周，甲状腺激素水平处于甲状腺功能减退范围。
对于甲状腺手术治疗后难治性甲状腺功能亢进患者，应进行放射性碘扫描以诊断或排除卵巢肿块的功能性特征。
