Struma Ovarii Follow-up

Updated: May 17, 2022
  • Author: Lisa Rubinsak, MD; Chief Editor: Michel E Rivlin, MD  more...
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Further Inpatient Care

For patients with a benign struma ovarii, standard surgical follow-up is sufficient.

For patients with malignant disease on surgical pathology, postoperative adjuvant therapy with radio-ablative iodine-131 is recommended. After surgical staging, a thyroidectomy is suggested before adjuvant treatment to potentiate the effects of radioablation. As normal thyroid cells preferentially uptake I-131, thyroidectomy would ensure delivery to the malignant cells. Additionally, a thyroidectomy would provide pathological confirmation that the struma is indeed ovarian in origin.

It is crucial for the surgeon to be aware of the intra- and postoperative complications of thyroidectomy (including hypocalcemia, damage to the recurrent laryngeal nerve, and/or need for postoperative thyroid replacement), and to be comfortable with their management. Radioactive I-131 ablation has been shown to treat malignant disease in both its initial presentation and any subsequent recurrence with excellent efficacy, although the rarity of the disease and lack of data surrounding its long-term management prove challenging to clinicians. [11]

Thyroglobulin is the preferred tumor marker followed in patients with malignant struma ovarii and should be followed sequentially after surgery and ablation. Increases in serum thyroglobulin should be followed up with total body scanning to detect recurrence, which is treated with subsequent radioablation. [18]