{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:04:08Z","timestamp":1774933448820,"version":"3.50.1"},"reference-count":10,"publisher":"Bioscientifica","issue":"6","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Thyroid J"],"published-print":{"date-parts":[[2021]]},"abstract":"<b><i>Introduction:<\/i><\/b> Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. <b><i>Case Presentation:<\/i><\/b> A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng\/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng\/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng\/mL. After delivery, Tg decreased to 14 ng\/mL but, 6 months later, rose again and reached 31.9 ng\/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. <b><i>Discussion\/Conclusion:<\/i><\/b> As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and\/or by the high levels of hCG which is known to stimulate TSH receptors. <\/jats:p>","DOI":"10.1159\/000512735","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T22:02:00Z","timestamp":1611784920000},"page":"523-527","source":"Crossref","is-referenced-by-count":8,"title":["Malignant Struma Ovarii with Concurrent Thyroid Cancer: Outcomes during and after Pregnancy"],"prefix":"10.1530","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8704-5292","authenticated-orcid":false,"given":"Sara","family":"Donato","sequence":"first","affiliation":[]},{"given":"Helder","family":"Sim\u00f5es","sequence":"additional","affiliation":[]},{"given":"Valeriano","family":"Leite","sequence":"additional","affiliation":[]}],"member":"416","published-online":{"date-parts":[[2021,1,27]]},"reference":[{"key":"ref1","unstructured":"Goffredo P, Sawka AM, Pura J, Adam MA, Roman SA, Sosa JA. Malignant struma ovarii: a population-level analysis of a large series of 68 patients. Thyroid<\/X00_Journal>. 2015 Feb;25(2):211\u20135."},{"key":"ref2","unstructured":"Gobitti C, Sindoni A, Bampo C, Baresic T, Giorda G, Alessandrini L, et al. Malignant struma ovarii harboring a unique NRAS mutation: case report and review of the literature. Hormones<\/X00_Journal>. 2017 Jul;16(3):322\u20137."},{"key":"ref3","unstructured":"Oudoux A, Leblanc E, Beaujot J, Gauthier-Kolesnikov H. Treatment and follow-up of malignant struma ovarii: regarding two cases. Gynecol Oncol Rep<\/X00_Journal>. 2016 Jun;17:56\u20139."},{"key":"ref4","unstructured":"Fern\u00e1ndez Catalina P, Rego Iraeta A, Lorenzo Solar M, S\u00e1nchez Sobrino P. Estruma ov\u00e1rico maligno y c\u00e1ncer papilar de tiroides sincr\u00f3nicos. Endocrinol Nutr<\/X00_Journal>. 2016 Aug\u2013Sep;63(7):366\u20137."},{"key":"ref5","unstructured":"Ihalagama IR, Hewavisenthi SJ, Wijesinghe PS. Pregnancy following treated malignant struma ovarii. Ceylon Med J<\/X00_Journal>. 2004 Sep;49(3):90\u20131."},{"key":"ref6","unstructured":"Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid<\/X00_Journal>. 2017 Mar;27(3):315\u201389."},{"key":"ref7","unstructured":"Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J<\/X00_Journal>. 2017 Sep;6(5):225\u201337."},{"key":"ref8","unstructured":"Sun SC, Hsu PJ, Wu FJ, Li SH, Lu CH, Luo CW. Thyrostimulin, but not thyroid-stimulating hormone (TSH), acts as a paracrine regulator to activate the TSH receptor in mammalian ovary. J Biol Chem<\/X00_Journal>. 2010 Feb;285(6):3758\u201365."},{"key":"ref9","unstructured":"Brogioni S, Viacava P, Tomisti L, Martino E, Macchia E. A special case of bilateral ovarian metastases in a woman with papillary carcinoma of the thyroid. Exp Clin Endocrinol Diabetes<\/X00_Journal>. 2007 Jun;115(6):397\u2013400."},{"key":"ref10","unstructured":"Sijian Li S, Yang T, Li X, Zhang L, Shi H, Cheng N, et al. FIGO stage IV and age over 55 years as prognostic predicators in patients with metastatic malignant struma ovarii. Front Oncol<\/X00_Journal>. 2020."}],"container-title":["European Thyroid Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/512735","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/512735","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T18:47:17Z","timestamp":1641494837000},"score":1,"resource":{"primary":{"URL":"https:\/\/etj.bioscientifica.com\/doi\/10.1159\/000512735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,11,12]]},"published-print":{"date-parts":[[2021,11,30]]}},"URL":"https:\/\/doi.org\/10.1159\/000512735","archive":["Portico"],"relation":{},"ISSN":["2235-0640","2235-0802"],"issn-type":[{"value":"2235-0640","type":"print"},{"value":"2235-0802","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]}}}