The interplay of Graves' disease and twin molar pregnancy.

Twin molar pregnancy with coexistent viable fetus in a patient with Graves' disease is a rare entity. The patient is a 37-year-old woman who was hospitalised owing to persistent vomiting and vaginal bleeding. The pregnancy test was positive and the pelvic ultrasound disclosed twin gestation of complete mole and a coexistent viable 12-week fetus. ß-Human chorionic gonadotropin (ß-HCG) and free thyroid hormones were both elevated. The patient was also a diagnosed case of Graves' disease prior to this pregnancy. Given the risks for perinatal complications, the patient was offered early termination of pregnancy. She, however, decided to continue her pregnancy and control the hyperthyroidism with an antithyroid drug (ATD). A week after her discharge from the hospital, she had spontaneous abortion and the histopathology of the abortus revealed complete hydatidiform mole and a 13-week fetus.

Papillary thyroid-type carcinoma arising from struma ovarii.

Malignant transformation of benign monodermal teratoma is a rare presentation of struma ovarii. A 41-year-old Filipina presented with 1-year history of recurrent lower abdominal pain, abdominal swelling and vomiting. Ultrasound of the abdomen revealed a large cystic abdomino-pelvic mass densely adherent to the intestinal and uterine wall with moderate ascitis. The patient underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy and histopathology showed papillary thyroid-type carcinoma arising from the left struma ovarii. She underwent total thyroidectomy, postoperative radioactive iodine ablation and maintained on levothyroxine suppressive therapy. She is now on regular follow-up for monitoring of possible tumour recurrence and metastasis.