Twisted Ovarian Cyst, Galactorrhea and Pituitary Hyperplasia Misdiagnosed as Prolactinoma: An Overlooked Longstanding Overt Hypothyroidism from Hashimoto’s Thyroiditis
Abstract
We describe a 14-year-old girl who was referred for management of a prolactin-secreting pituitary adenoma as she had persistent milky discharge from her nipples, an elevated prolactin level and pituitary enlargement. Upon reviewing the medical history, it was noted that she had a history of secondary amenorrhea for 1 year, and had undergone an oophorectomy for twisted left ovarian cyst 5 months earlier. The physical examination found that she had a goiter, short stature and was relatively overweight. Based on these findings, it was thought that the patient likely had longstanding overt hypothyroidism. A thyroid function test (TFT) revealed a free thyroxine (FT4) level of 0.2 ng/dL and thyroid stimulating hormone (TSH) >100 mU/L, with high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis. After 8 months of levothyroxine treatment, the galactorrhea had disappeared, the pituitary enlargement had resolved and her menstruation had resumed normally, along with a 4-kg weight loss and 3-cm height gain. In summary, when evaluating a girl with ovarian cyst(s), especially if accompanied by other clinical findings like goiter, short stature, or menstrual irregularities, the physician should include hypothyroidism in the differential diagnosis. Early diagnosis and treatment of hypothyroidism can have a positive impact on the overall health and well-being of these patients, potentially preventing further complications related to both the thyroid disorder and ovarian cyst(s).
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Rallison ML, Dobyns BM, Keating FR, Rall JE, Tyler FH. Occurrence and natural history of chronic lymphocytic thyroiditis in childhood. J Pediatr 1975;86:675-82.
Ralli M, Angeletti D, Fiore M, D’Aguanno V, Lambiase A, Artico M, et al. Hashimoto’s thyroiditis: an update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev 2020;19:102649.
Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones 2011;10:207-14.
Özen S, Berk Ö, Şimşek DG, Darcan Ş. Clinical course of Hashimoto’s thyroiditis and effects of levothyroxine therapy on the clinical course of the disease in children and adolescents. J Clin Res Pediatr Endocrinol 2011;3:192.
Radetti G, Maselli M, Buzi F, Corrias A, Mussa A, Cambiaso P, et al. The natural history of the normal/mild elevated TSH serum levels in children and adolescents with Hashimoto’s thyroiditis and isolated hyperthyrotropinaemia: a 3-year follow-up. Clin Endocrinol (Oxf) 2012;76:394-8.
Kucharska AM, Witkowska-Sedek E, Labochka D, Ruminska M. Clinical and biochemical characteristics of severe hypothyroidism due to autoimmune thyroiditis in children. Front Endocrinol (Lausanne) 2020;11:364.
Tresa A, Rema P, Suchetha S, Dinesh D, Sivaranjith J, Nath AG. Hypothyroidism presenting as ovarian cysts—A case series. Indian J Surg Oncol 2021;12:343-7.
Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics 2010;125:532-8.
Alzebidi JA, Almushri K, Elmoheen R. Spontaneous ovarian hyperstimulation syndrome associated with primary hypothyroidism. Cureus 2023;15:e33247.
Sapkota S, Karn M, Sapkota S. Pituitary hyperplasia in childhood primary hypothyroidism: a review. Childs Nerv Syst 2021;37:749-62.
Bhattacharya D, Kumar R, Yadav J. Pituitary macroadenoma secondary to Hashimoto’s thyroiditis: inadvertent diagnosis in a pre-pubertal girl. Trop Doct 2020;50:240-2.
Zhang M, Jiang W, Li G, Xu C. Ovarian masses in children and adolescents - an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol 2014;27:e73-7.
Wang Q, Yu D, Wang F. Clinical and computed tomographic features of ovarian lesions in infants, children, and adolescents: a series of 222 cases. J Pediatr Adolesc Gynecol 2021;34:387-93.
Khawaja NM, Taher BM, Barham ME, Naser AA, Hadidy AM, Ahmad AT, et al. Pituitary enlargement in patients with primary hypothyroidism. Endocr Pract 2006;12:29-34.
Kumar S, Sarathi V, Lila AR, Sehemby M, Memon SS, Karlekar M, et al. Giant prolactinoma in children and adolescents: a single-center experience and systematic review. Pituitary 2022;25:819-30.
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