Katulande P, Kariyawasam S S M, Senanayake H M, Weerakkodi M
Department of General Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka.
J Obstet Gynaecol. 2013 Jan;33(1):17-9. doi: 10.3109/01443615.2011.565388.
Ovarian hyperstimulation syndrome (OHSS) is a well known but poorly understood iatrogenic complication of superovulation. Spontaneous OHSS has been reported with pregnancy, polycystic ovary syndrome, primary hypothyroidism and pituitary adenoma. Only a few cases of massive ovarian enlargement in non-pregnant women with primary hypothyroidism have been reported in the English literature. A definitive pathophysiology remains uncertain, although several postulations were proposed. A 23-year-old nulliparous woman presented with transient bloating of her abdomen associated with menstruation for the last four cycles. She had nausea, headache, faintness, galactorrhoea and clinical signs and symptoms of hypothyroidism (swelling in the hands and feet, cold intolerance, decreased activity, excessive sleepiness, loss of hair and dry skin) for 6 months. Thyroid stimulating hormone and serum prolactin levels were highly elevated (> 100 μg/l and 4,095 μg/l, respectively) and free thyroxine level was low. Abdominal ultrasound showed bilateral multiple thin-walled ovarian cysts. Contrast enhanced CT of brain showed a pituitary macroadenoma. Treatment with levothyroxine was started and showed marked clinical improvement with return to normal menstruation within 4 months. Serial ultrasound showed gradual regression of the ovarian cysts within 6 months. Serum prolactin level was gradually diminished. Awareness that ovarian and pituitary enlargement may be associated with severe hypothyroidism which can be managed successfully, will spare patients dangerous and unnecessary operative intervention for ovarian cysts or pituitary adenoma.
卵巢过度刺激综合征（OHSS）是一种已知但了解不足的超排卵医源性并发症。自发性OHSS已在妊娠、多囊卵巢综合征、原发性甲状腺功能减退和垂体腺瘤中报道过。英文文献中仅报道了少数原发性甲状腺功能减退的非妊娠女性出现大量卵巢增大的病例。尽管提出了几种假设，但确切的病理生理学仍不确定。一名23岁未生育女性在过去四个月经周期出现与月经相关的短暂腹部肿胀。她有恶心、头痛、头晕、溢乳以及甲状腺功能减退的临床体征和症状（手脚肿胀、不耐寒、活动减少、过度嗜睡、脱发和皮肤干燥）达6个月。促甲状腺激素和血清催乳素水平显著升高（分别>100μg/L和4095μg/L），游离甲状腺素水平降低。腹部超声显示双侧多个薄壁卵巢囊肿。脑部增强CT显示垂体大腺瘤。开始使用左甲状腺素治疗，4个月内临床症状明显改善，月经恢复正常。连续超声显示6个月内卵巢囊肿逐渐消退。血清催乳素水平逐渐降低。认识到卵巢和垂体增大可能与严重甲状腺功能减退有关，且这种情况可以成功治疗，将使患者避免因卵巢囊肿或垂体腺瘤而进行危险且不必要的手术干预。
