Intermittent ovarian and thyroid failure and spontaneous twin pregnancy

Intermittent failure of two endocrine systems is unusual and presents diagnostic and management challenges. We report a case of a young woman with intermittent thyroid and ovarian failure who had spontaneous twin gestation four years after the diagnosis of premature ovarian failure was made. This case demonstrates coincidental biochemical and clinical thyroid and ovarian failure both of which spontaneously resolved with no treatment, although subsequently irreversible hypothyroidism ensued after the initial recovery. Elevated gonadotrophins with a menopausal pattern on more than one occasion, in an amenorrhoeic patient with menopausal symptoms, usually indicates permanent ovarian failure. This case demonstrates that this may not be true and while this is probably a rare occurrence, clinicians need to be aware of this possibility. It also re-emphasizes the need to consider the clinical picture when interpreting biochemical results.