PRIMARY HYPOTHYROIDISM ASSOCIATED WITH MULTICYSTIC OVARIES AND OVARIAN TORSION IN AN ADULT

Background: Primary hypothyroidism is known to be associated with mult icystic ovaries in juvenile females, but this association has been rep orted only once previously in an adult. This report describes an unusu al case of bilateral multicystic ovaries occurring in an adult patient with profound hypothyroidism. Case: A 26-year-old woman presented wit h an acute abdomen and bilateral adnexal masses. An emergency explorat ory laparotomy revealed bilateral enlarged multicystic ovaries with to rsion of the right ovary. Because this ovary was necrotic, it was remo ved; pathology revealed multiple hemorrhagic follicular cysts. Laborat ory studies to evaluate the cause of the multicystic ovaries revealed negative serum beta-hCG, LH 0.7 IU/L, FSH 15.7 IU/L, and estradiol 80 pg/mL. The TSH value was greater than 50 IU/L and serum thyroxine was undetectable, demonstrating profound hypothyroidism. Subsequent thyroi d hormone replacement was associated with resolution of the cysts in t he remaining ovary. Conclusion: Profound hypothyroidism can cause mult icystic ovaries in an adult. In the absence of ovarian torsion, surger y can be avoided, as thyroid hormone replacement leads to clinical res olution of the cysts within 3 months.