Coexistence of Graves' disease and unilateral functioning Struma ovarii: a case report.

BACKGROUND: Coexisting of Graves' disease and functioning struma ovarii is a rare condition. Although the histology of struma ovarii predominantly composed of thyrocytes, the majority of the patients did not have thyrotoxicosis. The mechanism underlying the functioning status of the tumor is still unclear but the presence of thyroid stimulating hormone receptor (TSHR) is thought to play a role. Here we describe the patient presentation and report the TSHR expression of the tumor. CASE PRESENTATION: A 56-year old Asian woman presented with long standing thyrotoxicosis for 23 years. She was diagnosed with Graves' disease and thyroid nodules. She had bilateral exophthalmos and had high titer of plasma TSHR antibody. Total thyroidectomy was performed and the histologic findings confirmed the clinical diagnosis. The patient had persistent thyrotoxicosis postoperatively. Thyroid uptake demonstrated the adequacy of the thyroid surgery and the whole body scan confirmed the presence of functioning thyroid tissue at pelvic area. The surgery was scheduled and the patient had hypothyroidism after the surgery. The pathological diagnosis was struma ovarii at right ovary. We performed TSHR staining in both the patient's struma ovarii and in 3 cases of non-functioning struma ovarii. The staining results were all positive and the intensity of the TSHR staining of functioning struma ovarii was the same as that in other cases of non-functioning tumors, suggesting that the determinant of functioning struma ovarii might be the presence of TSHR stimuli rather than the intensity of the TSHR in the ovarian tissue. CONCLUSION: In patients with Graves' disease with persistent or recurrent thyrotoxicosis after adequate ablative treatment, the possibility of ectopic thyroid hormone production should be considered. TSHR expression is found in patients with functioning and non-functioning struma ovarii and cannot solely be used to determine the functioning status of the tumor.

Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index.

OBJECTIVE: To assess the internal consistency, test-retest reliability, and validity of the Thai version of the Pittsburgh Sleep Quality Index (Thai-PSQI), which was recently translated using a standardized method, in Thai patients with major sleep disorders. MATERIAL AND METHOD: The Thai-PSQI was developed under a standard translation protocol and administered to "bad" sleepers (i.e. patients with suspected obstructive sleep apnea [OSA], depression, or insomnia) and "good" sleepers in an academic tertiary care setting. All participants were asked to complete the same questionnaire after 2-4 weeks. RESULTS: A total of 138 participants consisting of 69 patients with OSA, 28 with major depression, 11 with primary insomnia, and 30 controls completed the questionnaire. The global scores of the Thai-PSQI revealed that it had excellent internal consistency (Cronbach's alpha = 0.837) and test-retest reliability (intraclass correlation coefficient = 0.89). An analysis of covariance demonstrated a significant difference in Thai-PSQI global score between good sleepers and bad sleepers (p < 0.001). A cut-off point of 5 out of 6 on the global score resulted in a sensitivity of 77.78% and specificity of 93.33%. CONCLUSION: The Thai-PSQI is a valid and reliable tool for screening and identifying the presence of significant sleep disturbances, and is comparable to the original English version.