Prabha Krishna, Jebasingh K Felix, Londhe Vaibhav, Thomas Nihal
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Obstetrics and Gynaecology, Unit II, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Endocrinol Diabetes Metab Case Rep. 2024 Sep 27;2024(3). doi: 10.1530/EDM-23-0084. Print 2024 Jul 1.
Ovarian hyperstimulation syndrome (OHSS) usually occurs in patients undergoing assisted reproduction techniques and ovulation induction. Its variant, spontaneous ovarian hyperstimulation syndrome, a potentially life-threatening disorder, is uncommon and only a few cases have been reported in association with hypothyroidism. This study analysed five patients with untreated chronic hypothyroidism presenting with multicystic ovaries, isosexual precocious puberty, and delayed bone age; subsequently, the follow-up and regression of ovarian pathology was assessed. Two patients had presented to the emergency department with menorrhagia and hypotension, of these, one had ovarian torsion at presentation. Three patients presented to the outpatient department: one for evaluation of short stature, one for premature menarche, and another with polycystic ovaries. They were all diagnosed with long-standing, untreated chronic hypothyroidism. There was regression of the size of the cystic ovaries on subsequent follow-up. In all these patients, long-standing hypothyroidism had resulted in ovarian hyperstimulation syndrome. The potentially life-threatening complications of this syndrome may be prevented by careful screening and a strong index of clinical suspicion at the outset.
Long-standing, untreated primary hypothyroidism may result in spontaneous ovarian hyperstimulation syndrome. A high index of suspicion is required for an early and accurate diagnosis. The requirement for interdepartmental collaboration between gynaecology and endocrinology departments is essential for the successful management of this life-threatening but easily treatable disorder.
卵巢过度刺激综合征（OHSS）通常发生在接受辅助生殖技术和促排卵治疗的患者中。其变异型，即自发性卵巢过度刺激综合征，是一种潜在的危及生命的疾病，较为罕见，仅有少数病例报道与甲状腺功能减退有关。本研究分析了5例未经治疗的慢性甲状腺功能减退患者，这些患者表现为多囊卵巢、同性性早熟和骨龄延迟；随后评估了卵巢病变的随访及消退情况。2例患者因月经过多和低血压就诊于急诊科，其中1例就诊时发生卵巢扭转。3例患者就诊于门诊：1例因身材矮小前来评估，1例因初潮过早前来评估，另1例有多囊卵巢。她们均被诊断为长期未经治疗的慢性甲状腺功能减退。在随后的随访中，多囊卵巢的大小有所消退。在所有这些患者中，长期甲状腺功能减退导致了卵巢过度刺激综合征。通过仔细筛查和一开始就具备高度的临床怀疑指数，可预防该综合征潜在的危及生命的并发症。
长期未经治疗的原发性甲状腺功能减退可能导致自发性卵巢过度刺激综合征。早期准确诊断需要高度的怀疑指数。妇产科和内分泌科之间的跨部门合作对于成功管理这种危及生命但易于治疗的疾病至关重要。
