Spontaneous Severe Ovarian Hyper Stimulation Syndrome Associated with Massive Pericardial Effusion and Hypothyroidism in Non-pregnant Woman

Excerpt

An 18-year-old female patient presented with lump hypogastrium since one month. Lump was initially small in size but increased progressively to attain the present size. She also complained of non-specific, non-localized abdominal pain which was chronic, dull aching in nature, and non-radiating. It was mild in severity with no aggravating or relieving factors. Bladder and bowel habits were normal. She had an irregular menstrual cycle of 30–60 days, 1–2 days duration and scanty flow. She had no history of previous medication or hospitalization. On examination, two discrete tender lumps, 7–9 cm in size and firm in consistency, and well-defined margins present in hypogastrium. Per vaginal examination could not be performed due to denial of consent due to virgin status. All laboratory investigations were within normal limit except hemoglobin which was 5.9 mg% and low T3 0.10 ng/ml (normal 0.7–2.0 ng/ml), low T4 1.2 µg/dl (normal 5.5–13.5 µg/dl), and high TSH 102 µlu/ml (normal 0.3–5.0 µlu/ml) levels. CA 125 and other tumor markers were within normal limits. Ultrasonography at the time of admission showed bilateral enlarged ovaries of size 15.22 × 8.26 cm(Rt. Ovary) and 11.82 × 6.24 cm (Lt. ovary) with multiple cysts of varying sizes in both ovaries, giving a classical ‘spoke wheel-like appearance.’ A diagnosis of bilateral ovarian cysts was made, and diagnostic laparoscopy was planned for further management. On pre-anesthetic cardiopulmonary evaluation, pericardial effusion was suspected. Hence, cardiology opinion was taken and subsequent echocardiogram revealed massive pericardial effusion. Then, on the basis of previous findings and echocardiogram put together, a diagnosis of spontaneous severe ovarian hyper stimulation syndrome (OHSS) was made. …