GRAVE’S DISEASE AND PCOS, A CASE REPORT IN SECONDARY RURAL HEALTH CARE FACILITY

Abstract

INTRODUCTION
Autoimmune thyroiditis and plycystic ovary syndrome (PCOS) are proposed to have bidirectional relationship. In Grave’s disease this rare combination seems interesting. We reported an interesting case of PCOS in Grave’s disease.

CASE
A 21-year-old female single, Chinese Indonesian, of normal weight, menarche at age of 12 sought consult to our internal medicine clinic. She was apparently well until 5 years ago complaining of goiter, palpitations, tremors, hair loss, and weight loss. She had no menstrual irregularities. She was diagnosed as Graves disease by a private physician and clinically improved after having thiamazole 10 mg BID. She started complaining of amenorrhea 2 months prior and sought consult to our internal medicine clinic. Physical examination revealed diffuse goiter with no bruit, no fine tremor, no hirsutism, thyroid function test was normal. Thyroid ultrasound was suggestive of Graves disease. Gynecologic referral was done and ultrasound revealed multiple ovarian cysts. She was diagnosed with PCOS according to Rotterdam criteria and got her menstrual cycle again after 1 and a half month treatment with metformin 500 mg BID.

CONCLUSION
It is important for physicians to investigate PCOS in Graves disease with menstrual problem.