Abstract
Hypothyroidism can cause significant reproductive morbidity and its association with ovarian cyst formation is rare and when it occurs in children, it is referred to as Van Wyk and Grumbach syndrome. An 18-year-old girl was referred to our emergency services with suspicion of torsion ovarian cyst with USG findings as she had pain abdomen and vomiting of 3 days duration. She was provisionally prepared for laparoscopic surgery but on revaluation by USG bilateral thecaleutein cysts measuring 7x6.8x3.5 cms (right) and 10x6.8 x3.2 cms (left) were diagnosed. Her TSH level was 483 mI U/L . On probing she revealed past history of diagnosis of hypothyroidism and discontinuation of thyroxin therapy after taking for 6 months. Her anti TPO antibodies were >1300 IU/mL. USG thyroid revealed features suggestive of Hashimoto’s thyroiditis. She was counselled and started on thyroxin therapy with a dose of 4µg/kg and after 2 months of follow up the ovarian cysts have regressed and ovaries appeared normal on USG.
Highlights
Adnexal masses are rare in adolescents and paediatric age group and the incidence of malignancy is reported to be 10% approximately (Wyk & Grumbach, 1960)
The causes of bilateral ovarian enlargements include PCOS, Tuberculosis, Endometriosis and Germ cell tumours in the adolescents and young adults
Fertility preservation is the standard of care in adolescents and the guidelines need to be strictly adhered to when managing adolescents with ovarian masses
Summary
Adnexal masses are rare in adolescents and paediatric age group and the incidence of malignancy is reported to be 10% approximately (Wyk & Grumbach, 1960). The causes of bilateral ovarian enlargements include PCOS, Tuberculosis, Endometriosis and Germ cell tumours in the adolescents and young adults. It is of utmost importance for the clinician to understand the differential diagnosis and facilitate correct management surgical and non-surgical. There is no family history of thyroid dysfunction, heart disease, diabetes, tuberculosis or malignancies Figure 1: shows normal uterus in the centre and enlarged cystic ovaries on either side She received one unit of packed cell transfusion for anaemia and analgesics for pain relief Her investigations on 7.7.2020: TSH - was 483; T3 1.94; T4 0.32; Anti-TPO antibodies- >1300; GTT- 102/206/151.; Hormonal Profile –LH: 0 FSH -5.3 IU/L ; S.
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