Fromstruma ovariito Hashimoto disease—an unusual diagnosis of primary hypothyroidism: Case report

Abstract

Struma ovarii is a type of mature teratoma in which thyroid tissue forms the main component. In most cases struma ovarii is composed of normal thyroid tissue while lymphocytic thyroiditis in struma ovarii occurs very rarely. The authors report a case of a 52-year-old woman after ovarian tumor excision. In histopatholgical examination struma ovarii with chronic lymphocytic inflammation was diagnosed. Additional studies revealed a typical ultrasonographic picture of Hashimoto disease in the thyroid gland and an increased concentration of thyroglobulin antibodies. A final diagnosis of Hashimoto disease was confirmed. Initially, thyroid gland function was normal but 11 months after surgery, supplementation therapy with thyroxin was administered. In this case, an early diagnosis of Hashimoto disease resulted from excision of struma ovarii with chronic lymphocytic inflammation. It induced early thyroxin treatment and allowed to reduce hypothyroidism symptoms.

Struma Ovarii With the Coexistence of Hashimoto’s Thyroiditis: A Case Report

“…Although SO can be detected at any age even in childhood, it is mostly observed in the reproductive age (16). In the recent report, the patient was in a reproductive age, which is similar to other previous evaluations (8,9,(13)(14)(15). However, some reports of the ovarian stroma are available in the 5th and 6th years of life or under 20 years (8,9,15).…”

“…Although the diagnostic criteria for SO is based on the histologic appearance of the ovarian sample, it is sometimes necessary to determine the origin of the cell by immunohistochemistry staining for thyroglobulin (13). In the recent report which was similar to previous investigations (8,9,(13)(14)(15), the probability of a dermoid cyst was noted in the sonographic report, which was finally diagnosed as SO.…”

“…In a report, remission was noted after 11 months of follow-up and treatment (8) and in another case regarding a malignant SO with peritoneal involvement and multiple papillary thyroid cancer, the remission was observed after 104 months of follow-up (14). The probability of malignant SO should be considered in patients with a history of autoimmune thyroiditis and surgery for benign SO because the prognosis is difficult and may be performed years after the initial diagnosis (14).…”

“…However, regarding the thyroid function, the symptoms of subclinical Hashimoto's hypothyroidism and increased thyroglobulin antibody levels were noted and levothyroxine was administered accordingly, although this problem has been reported in previous reports, other reports mentioned normal anti-thyroid antibody with clear signs of hypothyroidism. (8,9,17,18).…”

“…Although it is commonly composed of normal thyroid tissue, the concurrent lymphocytic infiltration of the thyroid gland, as found in Hashimoto's thyroiditis and the ectopic thyroid tissue are extremely rare cases (8,9).…”