From the Guidelines
The management of malignant struma ovarii with elevated Thyroglobulin (TG) levels involves total thyroidectomy as a crucial step, followed by radio-iodine imaging and ablation, to allow for the use of thyroglobulin as a tumor marker and to destroy any residual thyroid tissue.
Key Considerations
- Referral for total thyroidectomy is essential in the postoperative management of malignant struma ovarii, as it enables the subsequent use of radio-iodine imaging and ablation 1.
- Radio-iodine imaging and ablation are critical for detecting and destroying any residual thyroid tissue, as well as for identifying other functioning tissue 1.
- The use of thyroglobulin as a tumor marker is facilitated by the removal of the thyroid gland, allowing for more accurate monitoring of disease recurrence or progression 1.
- While some may argue that this approach is excessive, series reporting this standard of care have shown the best outcomes 1.
From the Research
Management of Malignant Struma Ovarii with Elevated Thyroglobulin (TG) Levels
The management of malignant struma ovarii with elevated Thyroglobulin (TG) levels involves a combination of surgical and medical approaches.
- Surgical excision is the mainstay of treatment, with a conservative surgical approach being a reasonable option, especially in patients of childbearing age 2.
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy may be performed, followed by total thyroidectomy 3.
- Thyroidectomy and 131iodine therapy should be considered, with the management being similar to that of metastatic thyroid cancer 3.
Role of 131Iodine Therapy
- 131Iodine therapy may be used to treat malignant struma ovarii, with a dose of 150mCi being administered after total thyroidectomy 4.
- The 131I whole-body scintigraphy (WBS) may be used to detect residual thyroid tissue and implantation metastasis 4.
Follow-up and Monitoring
- Yearly follow-up with CT scan and tumor markers may be performed to monitor the patient's condition 5.
- Annual controls with thyroid ultrasound and serum tests may also be performed by an endocrinologist 5.
- Serum thyroglobulin (Tg) levels may be used as a marker of relapse, with elevated levels indicating possible recurrence 2, 3, 5, 4, 6.
Multimodal Management
- A multimodal management approach, involving a team of specialists, may be necessary to manage malignant struma ovarii, especially in cases with disseminated disease 6.
- This approach may include surgical staging, thyroidectomy, 131Iodine therapy, and secondary debulking, as well as the use of lithium pretreatment and 18 fluorodeoxyglucose positron emission tomography scan 6.