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Struma Ovarii With Hyperthyroidism.

Lynn P Ang1, Anca M Avram, Richard W Lieberman

  • 1From the *Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, †Nuclear Medicine, Department of Radiology, and ‡Department of Pathology, University of Michigan, Ann Arbor, MI.

Clinical Nuclear Medicine
|April 11, 2017
PubMed
Summary
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Persistent thyrotoxicosis was diagnosed in a woman despite treatment. Advanced imaging revealed a rare ovarian tumor (struma ovarii) as the cause, highlighting the importance of specialized imaging techniques.

Area of Science:

  • Nuclear Medicine
  • Endocrinology
  • Gynecologic Oncology

Background:

  • Thyrotoxicosis is a common endocrine disorder, often managed with medication or radioactive iodine therapy.
  • Persistent thyrotoxicosis despite standard treatment necessitates investigation into alternative etiologies.
  • Ovarian teratomas, specifically struma ovarii, can rarely cause hyperthyroidism.

Observation:

  • A 61-year-old woman presented with a 7-year history of persistent thyrotoxicosis.
  • Initial iodine-131 whole-body scans showed low thyroidal uptake and were negative for ectopic sources.
  • Methimazole treatment was ineffective, and hyperthyroidism persisted even after drug discontinuation.

Findings:

  • Repeat imaging with SPECT/CT demonstrated markedly low thyroidal radioiodine uptake (2%).

Related Experiment Videos

  • Intensely focal radioiodine uptake was identified in a large, heterogeneous left pelvic mass.
  • Histopathological examination of the resected mass confirmed benign struma ovarii.

    • Implications:

    • Fusion SPECT/CT imaging is crucial for diagnosing extrathyroidal thyrotoxicosis, especially when planar imaging is inconclusive.
    • Struma ovarii should be considered in the differential diagnosis of persistent thyrotoxicosis with low thyroidal uptake.
    • Advanced imaging techniques improve diagnostic accuracy for rare causes of endocrine disorders.