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Thyroid Factor

The Natural Thyroid Diet

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Figure 1-32. Struma ovarii results from the presence of thyroid tissue that becomes hyperactive in an ovarian teratoma. A, Typical gross appearance of a struma ovarii. Note that the tumor is composed almost entirely of thyroid tissue. Reproduced with permission from Rosai J. Ackerman's surgical pathology. 8th ed. Mosby-Year-book; 1996. B, Photomicrograph of the specimen in A reveals relatively normal thyroid tissue except for some follicular dilatation. The thyroid tissue is surrounded by ovarian stroma consistent with the diagnosis of struma ovarii (hematoxylin and eosin; x100 original magnification). Reproduced with permission from Rosai J. Ackerman's surgical pathology. 8th ed. S. Louis: Mosby-Yearbook; 1996.

Figure 1-32. Struma ovarii results from the presence of thyroid tissue that becomes hyperactive in an ovarian teratoma. A, Typical gross appearance of a struma ovarii. Note that the tumor is composed almost entirely of thyroid tissue. Reproduced with permission from Rosai J. Ackerman's surgical pathology. 8th ed. Mosby-Year-book; 1996. B, Photomicrograph of the specimen in A reveals relatively normal thyroid tissue except for some follicular dilatation. The thyroid tissue is surrounded by ovarian stroma consistent with the diagnosis of struma ovarii (hematoxylin and eosin; x100 original magnification). Reproduced with permission from Rosai J. Ackerman's surgical pathology. 8th ed. S. Louis: Mosby-Yearbook; 1996.

tomatic individuals. Formal surgery is not possible because anatomic planes are not preserved in this disease. Corticosteroids have not been shown to be effective in diminishing the goiter size. Successful treatment with tamoxifen has been reported. Rarely, Riedel's struma, when bilateral, may result in both hypothyroidism and hypoparathyroidism.27

Thyroiditis Factitia

The deliberate intake of thyroid hormone, overdosage with thyroid hormone or from eating uncooked, fresh thyroid glands, can cause hyperthyroidism. Suspicion is key to diagnosis in thyrotoxic patients with a normal-size gland and low radioiodine uptake, especially if they or their relatives have had a history of intake of the thyroid hormone. A suppressed thyroglobulin level is also consistent with exogenous intake of thyroid hormone. Patients with factitious hyperthyroidism who take T3 have suppressed T4 levels. Treatment is to stop the intake of thyroid hormone with psychological therapy. Rarely, patients may acutely need sympathetic treatment with P-blockers.

Struma Ovarii

Struma ovarii is a thyroid hormone-secreting ovarian teratoma composed predominantly or exclusively of thyroid tissue (Figure 1-32). In these patients, RAI uptake occurs in the teratoma but not in the thyroid gland. Malignant transformation of the thyroid tissue in struma ovarii is uncommon and rarely recurs or metastasizes. This diagnosis is usually suspected in a patient with a pelvic mass and hyperthyroidism in the absence of goiter. It is confirmed by increased tracer uptake in the pelvis with a suppressed thyroid gland. Symptoms usually resolve with resection of the pelvic tumor. Occasionally, patients may need symptomatic treatment with antithyroid drugs. In malignant struma ovarii, radioactive iodine should be used following surgical excision and to treat the rare patient with recurrence or metastasis that cannot be removed surgically.27

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