Large ovarian cyst in a prepubertal girl associated with severe primary hypothyroidism: a case report

Ovarian cysts in prepubertal girls are uncommon and often raise concerns about torsion or malignancy. Severe primary hypothyroidism can cause ovarian enlargement and cyst formation as part of Van Wyk-Grumbach syndrome.

A 7-year-old prepubertal girl presented with acute lower abdominal pain. Imaging revealed a large, mildly complex left ovarian cyst, a smaller contralateral cyst, preserved vascularity, and no torsion. Laboratory evaluation showed profound primary hypothyroidism, elevated prolactin and estradiol levels, and delayed bone age. Due to the symptoms, cyst size, and mildly complex imaging findings, laparoscopic cyst excision was performed, confirming a benign cyst without torsion or malignancy. Following thyroid replacement therapy, endocrine parameters normalized, and the contralateral cyst regressed.

Although many ovarian cysts related to Van Wyk-Grumbach syndrome regress with levothyroxine alone, this case highlights the management dilemma when the presentation is acute and imaging raises concerns about complications.

Hypothyroidism should be included in the differential diagnosis of ovarian cysts in prepubertal girls. Routine thyroid function testing may guide early diagnosis, enable conservative management when appropriate, and help avoid unnecessary surgery.