Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report

Abstract

Objective To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism. Design Case report. Setting Endocrinology private practice. Patient(s) A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism. Intervention(s) Administration of levothyroxine and titration of the dose. Main Outcome Measure(s) Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy. Result(s) The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 μg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts. Conclusion(s) Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.

Aversion of surgical exploration in patients with complex ovarian cysts secondary to overt hypothyroidism: A series of three cases

“…There are multiple aetiologies for the formation of ovarian cysts in Hashimoto’s disease and long-standing hypothyroidism, but the most convincing one is the cross-reactivity of TSH, FSH and luteinising hormone (LH) due to the sharing of a common alpha chain 2. It is also postulated that there are TSH receptors on ovarian follicles, which on binding with TSH sensitises the action of FSH.…”

“…All these mechanisms can lead to multiple large cysts inside the ovary mimicking OHSS in the picture. Spontaneous OHSS in long-standing hypothyroidism has been described in the literature 2 4–7. Menstrual irregularities with hypothyroidism are well known but the occurrence is not documented in the literature, therefore the association of hypothyroidism with ovarian cysts is not established.…”

Ovarian Hyperstimulation syndrome combined with hypothyroidism: a comprehensive review

“…Through the analysis of 13 case reports on HT combined with OHSS in naturally pregnant women [42][43][44][45][46][47][48][49][50][51][52][53][54], it has been found that the average age of these patients was 26 years (M ± SD: 26 ± 4.26). Most pregnant women experienced OHSS between the 9th and the 14th weeks of pregnancy.…”

The Thyroid Hormone Axis and Female Reproduction

“…Furthermore, impaired thyroid function mediates attenuated gonadotropin secretion directly and through a rise in prolactin secondary to elevated TSH levels, which may also cross-react with FSH receptors, while elevated prolactin sensitizes the ovaries to gonadotropin action. Together, these effects enhance the risk of ovarian hyperstimulation syndrome in hypothyroid women [ 185 , 186 ]. Regardless, further investigation will be required to conclusively determine the pathways through which thyroid dysfunction is linked to a polycystic ovarian morphology since, as discussed previously, the mechanisms through which thyroid hormones may interact with the HPG axis or ovarian tissue are complex and multimodal.…”