Massive Ovarian Enlargement with Multiple Cysts Mimicking Ovarian Neoplasm and Primary Hypothyroidism

Abstract

Background: Cystic enlargement of ovaries may develop due a large number of causes and may need surgical intervention. Moreover, some ovarian cysts arise due to endocrine disorders & do not require surgery. We report an unusual case of massive enlargement of ovaries with multiple cysts in a girl with severe hypothyroidism. Morphologic features of cysts on ultrasonography and clinical features of hypothyroidism with elevated TSH level facilitates diagnosis of multiple ovarian cysts and hypothyroidism. Case presentation: A 23-year-old unmarried woman presented with abdominal enlargement, pain and moderate anemia. Abdominal ultra sonogram revealed huge enlargement of the ovaries with multiple large cysts. She was admitted in a hospital, treated with blood transfusion and laparotomy was decided. She was referred to us in a private clinic. On further evaluation , she had features of hypothyroidism with high TSH level and abdomino-pelvic ultrasound revealed enlarged ovaries with multiple large thin-walled cysts and mild ascitis. Conservative management with thyroxin replacement therapy was given and after 3 weeks of thyroxine (T4) therapy, follow-up abdominal ultrasound showed significant reduction in ovarian size. After 4 months of thyroxine therapy, ovarian size normalized, cysts disappeared completely and there was significant improvement of patient’s condition and she became euthyroid. Conclusion: This case report highlights the rare association between hypothyroidism and multicystic ovarian enlargement. It is necessary to keep in mind the possibility of hypothyroidism in the differential diagnosis of adult patients with ovarian enlargement and multiple cyst formation in order to prevent unnecessary ovarian surgery. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1): 78-81