Multicystic ovaries in untreated pediatric hypothyroidism a risk factor for ovarian torsion

Abstract

Background: In this case report, we hope to increase awareness of pediatric hypothyroidism as a cause of multicystic ovaries which increases the risk for ovarian torsion. By treating hypothyroidism, we can prevent such an occurrence. Case: A 13-year-old hypothyroid female presented with right lower quadrant abdominal pain and bilateral multicystic ovarian enlargement on sonography. There was a suspicion of right ovarian torsion which was confirmed by laparoscopy. Her TSH level was 997 μU/mL. The right ovary was significantly reduced in size after drainage, and ovariopexy was successfully done as the ovary was still viable after detorsion. The left ovariopexy failed as left ovary remained too large after drainage. Patient's levothyroxine dose was increased from a daily dose of 25 μg to 44 μg. Repeat ultrasound six weeks later showed a decrease in ovarian size and volume. Conclusion: Awareness of such an entity would spare a pediatric patient the complications of undertreated hypothyroidism such as multicystic ovaries which can be complicated by ovarian torsion. Those ovarian cysts tend to resolve with thyroid hormone replacement therapy and therefore prevent an unnecessary surgery and a serious complication like an ovarian torsion. Also, any pediatric patient diagnosed with polycystic ovaries should be screened for hypothyroidism. © Lebanese Order of Physicians. All rights reserved.