CLINICAL PRESENTATION: A 38 year old Filipina had a 3 days of colicky epigastric pain, vomiting and high grade fever. She had salphingooophorectomy for a left ovarian cystic teratoma in 1995, and is on propylthiouracil (PTU) and propranolol for Grave's disease since December 2004. However, thyrotoxicosis persisted. On admission, the abdomen was rigid and tenderness. Pelvic examinatin showed posterior cul de sac tenderness. TSH was 0.007 mIU/L (NV 0.3 - 3.8 mIU/L) while FT4 was 30.5 pmol/L (NV 11 - 24 pmol/L). Transvaginal ultrasound revealed an abdominopelvic mass. Burch-Wartofsky score was 35. Prior to surgery, PTU as retention enema, IV iodinated contrast, dexamethasone, and paracetamol were given. Exploratory laparotomy revealed a ruptured right cystic ovary. Histopathologic diagnosis was struma ovarii. FT4 remained elevated (38.1 to 46 pmol/L) postoperatively. Scintigraphy showed an enlarged thyroid with elevated 2 and 24 hour uptake. RAI was given after a year.Significance: Cystic variant of struma ovarii is rare, but coexistence of Graves disease and struma ovarii is even more uncommon, with only 12 other cases reported. This case is complicated by ovarian cysy rupture, resulting in an acute abdomen in a patient with impending thyroid storm.CONCLUSIONS: A high index of suspicion is necessary for the diagnosis of struma ovarii, especially with coexistent Graves' disease. Diagnosis should be considered in patients who remain thyrotoxic despite adequate treatment and in those with pelvic masses and concomitant thyrotoxicosis. Surgery for the struma ovarii should be emphasized as part of adequate treatment.
Human ; Female ; Adult ; Grave's Disease ; Struma Ovarii

BACKGROUND: Awareness regarding obstructive sleep apnea (OSA) in diabetic patients remains low. No inquiry into the quality of life of diabetics with OSA has been reported.

OBJECTIVES: Our primary objective was to determine the prevalence and associations of high OSA risk in adult diabetic Filipinos consulting at Philippine General Hospital. Secondary objectives included determining prevalence of excessive daytime sleepiness and the quality of life.

METHODOLOGY: This was a cross-sectional study. Saint Luke's Medical Center - Obstructive Sleep Apnea Clinical Score (SLMC-OSACS), Epworth Sleepiness Scale (ESS), and Audit of Diabetes Dependent Quality of Life questionnaire (ADDQoL) were used.

RESULTS: 317 subjects were recruited. Majority had type 2 diabetes. 21 percent had high OSA risk. True OSA prevalence is estimated at 14.1 percent. High OSA risk is associated with hypertension (68.1 percent vs. 49 percent, p=0.004), type II obesity (19.4 percent vs. 7.8 percent, p=0.004), increased waist circumference (mean 89.06+10.87 cm vs. 85.37+10.07 cm, p = 0.008), increased hip circumference (mean 99.73 + 9.36 cm vs. 96.62+7.68 cm, p=0.004), increased neck circumference (mean 36.09+3.66 cm vs. 34.85+4.19 cm, p=0.025) elevated serum triglyceride (mean 163.78 + 73.77 mg/dL vs. 138.73 + 67.28 mg/dL, p=0.007), metabolic syndrome (68.1 percent vs. 51 percent, p=0.011), and higher ESS score (mean 10.86 + 4.97 vs. 9.13 + 4.85, p=0.008). No significant difference in mean ADDQoL score was noted, although low risk subjects were more likely to report a good general quality of life (34.7 percent, p = 0.024).

CONCLUSIONS: The 14.1 percent estimated OSA prevalence is significant in light of its associations with cardiovascular risk factors. SLMC-OSACS and ESS are inexpensive bedside tools for OSA screening.