Is there a correlation between benign hemorrhagic ovarian cysts and autoimmune-related thyroid nodules, such as shared immune, hormonal, or inflammatory mechanisms?

Correlation Between Benign Hemorrhagic Ovarian Cysts and Autoimmune-Related Thyroid Nodules

There is no established physiologic or hormonal correlation between benign hemorrhagic ovarian cysts and autoimmune thyroid disease with nodules. These conditions appear to be independent findings that occurred concurrently rather than having a shared pathophysiological mechanism 1.

Understanding Benign Hemorrhagic Ovarian Cysts

• Hemorrhagic ovarian cysts are classified as O-RADS 2 lesions (almost certainly benign with <1% risk of malignancy) and are common findings in premenopausal women 1
• Typical hemorrhagic cysts demonstrate characteristic features including reticular patterns (fine thin intersecting lines representing fibrin strands) and/or retracting clots (avascular echogenic components with angular, straight, or concave margins) 1
• The pathology findings in this case (4.2 × 3.9 × 1.2 cm cyst wall fragment containing clotted blood and tan-gray tissue without excrescences or solid nodules) are consistent with a benign hemorrhagic cyst 1
• Hemorrhagic functional cysts typically decrease or resolve on sonographic follow-up in 8-12 weeks, while non-functional cysts persist 1

Understanding Autoimmune Thyroid Disease with Nodules

• Hashimoto's thyroiditis is characterized by a heterogeneous and hypervascular gland on ultrasound, consistent with autoimmune inflammation 1
• Thyroid nodules in the setting of Hashimoto's thyroiditis require evaluation with fine-needle aspiration biopsy (FNAB) to confirm pathological diagnosis 1
• The right thyroid nodule (3 cm, solid, isoechoic, smooth, encapsulated with NRAS mutation) and left thyroid nodule (1.0-1.2 cm, solid, isoechoic with smooth halo and benign cytology) represent common findings in patients with Hashimoto's thyroiditis 1

Evidence Against a Direct Correlation

• Current clinical guidelines for ovarian cysts and thyroid nodules do not mention any established correlation between these two conditions 1
• The O-RADS US risk stratification system and management guidelines for ovarian cysts do not include thyroid disease as a risk factor or associated condition 1
• Similarly, guidelines for thyroid nodule management do not mention ovarian pathology as a related condition 1

Limited Case Reports of Associations

• There are isolated case reports of ovarian cysts occurring in the setting of severe hypothyroidism, particularly in young women 2, 3, 4
• These cases typically involve multiple ovarian cysts that resolve with thyroid hormone replacement, suggesting a different mechanism than the single hemorrhagic cyst described in this case 2, 3
• The pathophysiology in these reported cases involves markedly elevated TSH levels (often >100 mIU/L) rather than the autoimmune inflammation itself 2, 4

Clinical Implications

• Both conditions should be managed according to their respective standard protocols 1
• For the hemorrhagic ovarian cyst, surgical removal was appropriate management, particularly given its size (>3 cm) and symptomatic presentation 1
• For thyroid nodules in the setting of Hashimoto's thyroiditis, continued monitoring and appropriate management based on size, ultrasound features, and cytology findings is recommended 1

Conclusion

The concurrent presentation of a benign hemorrhagic ovarian cyst and autoimmune thyroid disease with nodules appears to be coincidental rather than causally related. Each condition should be managed according to its specific clinical guidelines, with no evidence supporting a need for modified management due to their co-occurrence 1.