Struma ovarii medical therapy

The mainstay of treatment for struma ovarii is surgical therapy. Chemotherapy doesn’t seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. Adjuvant treatment modalities such as radioiodine therapy and external beam radiation are recommended.

Chemotherapy doesn’t seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. ^[1][2]

• First line of management to be considered for malignant struma ovarii is thyroidectomy and treatment with radioiodine I-131. ^[3][4][5]
• Radioiodine therapy has good outcomes in residual disease or metastatic/recurrent disease. ^[5]
• Iodine scans have been preferred in the detection of recurrent disease after termination of therapy. ^[6]

Recommendations: ^[7]

• Post 6 months after the end of treatment:

• Routine clinical examination
• Measure serum thyroglobulin
• Diagnostic I-131 scintigraphy (after rhTSH stimulation or withdrawal)

• Every 6 months for 18 months and every year thereafter:

• The mainstay follow-up of clinical examination and thyroglobulin measurements with TSH suppression (thyroglobulin must be < 1 ng/ml).
• Additional imaging such as I-131 scintigraphy, 18-FDG-PET, ultrasonography, CT and/or MRI must be performed in the case of abnormal results.
• Pelvic locations help explain complementary imaging, adapted to the initial stage of the disease.

External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. ^[8]

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