Differentiating Struma ovarii from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]


Struma ovarii is a potentially malignant tumor, that should be differentiated from an ovarian mass with cystic, solid, or mixed cystic and solid structure. Struma ovarii must be differentiated from other diseases like benign and malignant ovarian neoplasmovarian cystendometrioma and tubo-ovarian abscess.

Differentiating Struma ovarii from other Diseases

Struma ovarii must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter:

Cause of thyrotoxicosis TSH receptor antibodies Thyroid US Color flow Doppler Radioactive iodine uptake/Scan Other features
Struma ovarii - Variable Reduced/absent flow Abdominal RAIU
Toxic nodular goiter - Multiple nodules - Hot nodules at thyroid scan -
Graves' disease + Hypoechoic pattern Ophthalmopathy, dermopathy, acropachy
Toxic adenoma - Single nodule - Hot nodule -
Subacute thyroiditis - Heterogeneous hypoechoic areas Reduced/absent flow Neck pain, fever, and
elevated inflammatory index
Painless thyroiditis - Hypoechoic pattern Reduced/absent flow -
Amiodarone induced thyroiditis-Type 1 - Diffuse or nodular goiter ↓/Normal/↑ ↓ but higher than in Type 2 High urinary iodine
Amiodarone induced thyroiditis-Type 2 - Normal Absent ↓/absent High urinary iodine
Central hyperthyroidism - Diffuse or nodular goiter Normal/↑ Inappropriately normal or high TSH
Trophoblastic disease - Diffuse or nodular goiter Normal/↑ -
Factitious thyrotoxicosis - Variable Reduced/absent flow ↓ Serum thyroglobulin


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