One day 3 months ago, a 24-year-old girl accompanied by her boyfriend came to the clinic of Dr. Hu Yongbin of the Department of Endocrinology of Hongkai Hospital. The girl was pale, her mouth and lips lacked the redness and luster of a young woman, her eyelids were slightly puffy, and she seemed sleepy. She was referred to the Department of Brain Surgery for consideration of pituitary prolactinoma and was prepared for pituitary surgery followed by laparoscopic ovarian cyst debulking. During the preparation for surgery, hypothyroidism (hypothyroidism) was discovered by chance, and the surgery was planned to be performed after several days of replacement therapy with eugenol (thyroxine tablets). Dr. Hu took a careful history and checked all the tests: T3 and T4 were significantly low, TSH was significantly elevated, estrogen was elevated, hematocrit was low, cholesterol was elevated, and there was a small amount of pericardial effusion, and he diagnosed “primary hypothyroidism” and warned the patient that pituitary and ovarian cysts were not feasible. They are both caused by “hypothyroidism”.
Hypothyroidism occurs in middle-aged and older women, mostly due to autoimmune thyroid disease, and is not an uncommon disease. However, in recent years, hypothyroidism is not uncommon in children and adolescent women, and its cause may be due to genetic defects. Hypothyroidism is like a slowing down of the body’s internal engine movement, as if a person is in hibernation, all metabolism is slowed down, body temperature can be low, digestion and absorption of various nutrients are weakened, malnutrition or iron deficiency anemia can occur; cholesterol metabolism is slowed down, hyperlipidemia can occur. In addition, primary hypothyroidism can lead to elevated prolactin levels, making it easy for infertile women to produce milk, which can be mistaken for pituitary prolactinoma and thus be mistakenly pushed to the operating table to receive a knife. In addition, because TSH and LH are similar in molecular structure, high levels of TSH can mimic the action of LH on the ovaries, leading to follicular membrane cell hyperplasia and ovarian cysts, and there are few cases of laparoscopic surgery for ovarian cysts by mistake. If a prepubertal girl has severe hypothyroidism, precocious puberty can occur because estrogen levels can be elevated.
This girl came back for a follow-up visit after 3 months of taking Eugenol and was surprised to find that her pituitary gland had returned to normal size, her ovarian cysts had magically disappeared, her face was significantly rosier, she had lost weight, her anemia, hyperlipidemia and pericardial effusion had all been corrected, and her delayed menstruation, which had been ineffective for years of treatment, had also healed, and she was completely refreshed compared to 3 months ago. She truly felt that this was the best moment of her life.