Case of thyrotoxicosis associated with struma ovarii: case report

Struma ovarii is a rare type of teratoma with predominant thyroid tissue comprising more than 50% of the overall mass and in some cases hormonal tumor activity results in clinical and biochemical signs of hyperthyroidism.We report on a 68-year-old postmenopausal female patient with Grave's disease treated 34 years prior by total thyroidectomy on levothyroxine replacement therapy presented with thyrotoxicosis.After thorough clinical investigation, imaging tests accompanied by elevated serum levels of CA 125 indicated right ovarian malignancy.The patient underwent bilateral adnexectomy and pathohistological results revealed struma ovarii.Although standard procedure in treating all germ cell tumors is conservative surgery, in our case the procedure was planned in accordance with the patient's age.In non-malignant tumors adjuvant therapy is not indicated, however annual serum thyroglobulin monitoring is advised in the first two postoperative years.Diverse clinical manifestation of this ovarian entity requires a multidisciplinary approach ensuring comprehensive care with a common interest of enhancing the patient's treatment outcome.