The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 6 3771-3772
Copyright © 2005 by The Endocrine Society
Scintigraphic Detection of Benign Struma Ovarii in a Hyperthyroid Patient
Twyla B. Bartel,
Malik E. Juweid,
Thomas O’Dorisio,
William Sivitz and
Patricia Kirby
Division of Nuclear Medicine (T.B.B., M.E.J.), Department of Radiology, Department of Endocrinology (T.O., W.S.), and Department of Pathology (P.K.), University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242
Address all correspondence and requests for reprints to: Dr. Twyla Bartel, Department of Radiology, PET Center, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242. E-mail: twyla-bartel{at}uiowa.edu.
A 54-YEAR-OLD WOMAN presented with episodes of increased sweating, palpitations, and emotional liability that occurred over a 2-yr period. The patient had undergone total thyroidectomy and radioiodine therapy 23 yr previously in Mexico for uncontrollable Graves’ disease and was maintained on various dosages of thyroid hormone since that time. Details concerning this treatment are unavailable. Laboratory values in later records indicate the patient was in a persistent hyperthyroid state and more so in the months before our seeing her. After discontinuing thyroid hormone for 1 month, TSH level measured less than 0.01 µIU/ml (normal range, 0.27–4.20), free T4 (FT4) was 2.18 ng/dl (0.93–1.70), and FT3 was 6.96 (1.30–4.60). A thyroid-stimulating Ig index of 5.0 (positive if 
1.9) indicated immune activation of underlying Graves’ disease. Subsequent scintigraphic imaging with Tc-99m-pertechnetate and then Na131I showed intense left ovarian uptake (Fig. 1
), whereas uptake in the neck was mild and confined to a small area of presumed residual thyroid tissue. A left pelvic mass was palpated on physical exam. Transvaginal ultrasound showed multiple hypoechoic structures consistent with follicles. The diagnosis of struma ovarii was suspected. The left ovary was surgically removed 1 month after scintigraphic imaging with histopathological confirmation of benign struma ovarii (Fig. 2). The patient was biochemically hypothyroid 1 month after surgery. Thyroid hormone intake was resumed, and 4 months later, the patient’s FT4 was 1.83 (0.8–2.0 at a foreign institution), FT3 was 4.2 (2.30–4.20), and TSH was 0.3 (0.4–7.0). The patient’s hyperthyroid symptoms have resolved.
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FIG. 1. Scintigraphic images demonstrating clearly more focal, intense uptake in the left ovary (arrows) compared with the more diffuse, low-grade uptake in the bowel. There is minimal residual thyroid bed uptake (arrowheads). A, Whole-body images 20 min after iv injection of 15.5 mCi (573.5 MBq) of Tc-99m-pertechnetate; B, whole-body images 4 h after iv injection of 1.1 mCi (40.7 MBq) of Na131I.
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FIG. 2. A, Thyroid follicles are seen lined by a single layer of cuboidal to columnar epithelium that contain colloid and dense amophilic secretions. No thyroid carcinoma was identified. The remaining tissue is ovarian stroma containing stubby spindle stromal cells. B, An immunohistochemical stain for thyroglobulin is positive in the follicular structures.
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Footnotes
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Abbreviation: FT4, Free T4.
Received January 25, 2005.
Accepted March 10, 2005.
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References
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