hypothyroidism-associated multicystic ovaries

Multicystic ovaries can be secondary to hypothyroidism. Most patients present with symptoms of precocious puberty, vaginal bleeding, abdominal distention, acute abdomen, massive cystic ovarian masses and ovarian torsion.

The pathophysiology of this entity is unclear. Various mechanisms have been proposed as to the cause of ovulatory dysfunction with formation of cysts, these include altered estrogen metabolism, hypothalamic-pituitary dysfunction, a direct effect on the ovaries or an altered prolactin metabolism.

Thyroid stimulating hormone (TSH), growth hormone (GH), follicle stimulating hormone (FSH), and luteinizing hormone (LH) have common alpha chains and it is their -chains that confer specificity.

Cross-reaction of very high TSH could produce FSH and LH-like activity responsible for the luteinized ovarian cysts.

Synopsis

 Gross: multiple cysts that contain clear fluid
 cysts lined by a single layer of ovoid cells with no evidence of luteinization or as follicular cysts
 numerous follicular cysts with a compact granulosa cell component, two to three cell layers thick, overlying a slightly luteinized theca interna.

 Other cysts can have a prominent granulosa cell proliferation that had an "immature" appearance with pleomorphism, slightly prominent nucleoli and brisk apoptotic and mitotic activity.

 The peripheral granulosa cell layer revealed prominent luteinization.

Immunochemistry

Inhibin A and CD 99 staining was intense on these elements confirming their granulosa cell nature.

Case records

 UPMC 496