Recombinant human thyrotropin use resulting in ovarian hyperstimulation: an unusual side effect

A 43-year-old female was administered recombinant human thyrotropin-α (Thyrogen®; Genzyme Corp., Cambridge, Mass., USA) before a fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan as part of an evaluation of thyroid cancer recurrence. She was administered two doses of Thyrogen only 4 weeks before for stimulated thyroglobulin measurement. The PET/CT scan demonstrated enlarged ovaries which on subsequent conservative follow-up resolved. This transient hyperstimulated state of the ovaries was presumed to be related to Thyrogen injections received twice within a space of a month. Thyrogen is being increasingly used for raising the level of thyroid-stimulating hormone (TSH), besides thyroid hormone withdrawal for suspected recurrence of differentiated thyroid carcinoma. Ovarian hyperstimulation has been reported as an iatrogenic complication for in vitro fertilization with the presence of human chorionic gonadotropin being invariably associated. Transient gestational thyrotoxicosis has been reported to be related to promiscuous activation of the thyrotropin receptor by chorionic gonadotropin. In our case it is possible that due to the promiscuous stimulation, thyrotropin caused a follicle-stimulating hormone (FSH)-like action resulting in ovarian hyperstimulation. The reason behind this could be the shared sequence identity of the hormone-binding domains of TSH and FSH receptors, or some mutation in the FSH receptor. In conclusion, our case highlights a potential side effect of administering Thyrogen in females of the reproductive age group.