Simple Cysts caused by Hypothyroidism? PCOS? Surgery needed?

[leecounty]

Had a miscarriage in March and longer than normal periods since (usually 10-14 days of bleeding, still 28-30 day cycle).  I started my period on July 23 and had it into August. Called Dr. and got in to see the gyno in mid-Sept (with period still going heavy). She had me get bloodwork for TSH, LH, FSH, Prolactin, and a transvaginal/pelvic ultrasound.  Bloodwork showed 6.22 TSH and 28 Prolactin, so saw a family practice doctor that made me get an MRI for a pituitary adenoma that came back showing my brain was just fine and said that I could wait 4 months to see the endocronologist to see what was up with my TSH and prolactin because I was likely had HYPERthyroidism.  (Keep in mind that I'm a fat girl that can't lose weight at all and am always wiped out).  Gyno finally called me back to let me know that I had a 5.4 cm "simple cyst" on the right ovary and a 3 cm simple cyst on the left. Told me to call back when I had my first day of my next period. When I said I was still bleeding heavily (Day 63 at that point), they told me it should stop soon and if it was still going in 3-4 weeks, give them a call.

Feeling utterly cast aside by the 'wait and see' while I was having 8-10 half dollar sized clots coming out a day and having to use both tampons and pads to not cause a stir or stain at work... I decided to go to the other hospital/clinic in town.

After they got my paperwork, they had me in the same day because of my condition. New Awesome Dr first stated that my elevated TSH and my very low end of normal free T4 indicated that I had HYPOthyroidism. (That's right, you read correctly! Even played dirty and called Dr at old clinic to see if she said HYPER and she said yes. Idiot!) Am now on 50 micrograms Levothyroxine per day. Also prescribed 10 days of Provera to stop bleeding (has worked like a charm for the last 6 days).

She also pointed out that while my FSH and LH are in the normal range (7.3 and 12.1 respectively), that the reverse ratio indicates I may have PCOS. I have no facial hair and don't seem to have problems eating sugar, but am going in tomorrow morning to have tests for cholesterol, sugar, androgens, and another prolactin one... because my first one was done at about 4 pm and prolactin raises during the day!

As soon as the Provera-induced period comes, I am to call them to set up my next ultrasound. The Dr. is also wondering if I have uterine polyps, so is doing the ultrasound with saline to puff things up. May also check fallopian tubes with saline and will be definitely looking at the ovarian cysts.  If they have not gone down in size, may be having surgery.

I've looked at other posts and all I see is people that have had cysts plus the associated ovary and maybe even the fallopian tube removed. Do they always remove the ovary with the cyst? What makes that determination? It just freaks me out because I have rather large cysts on each. I'm in my mid 30s, married last year, and we want to have kids! Most people we know have been saying that there are a lot of cute little kids out there to adopt, so don't fret. I don't want to hear that! I want to have my own!!!

Has anyone ever had a situation similar to this? Based on my research I've been doing over the past few weeks, it sounds like all this could be the result of the thyroid not doing it's job and throwing everything out of whack. Please help! And if you do, my husband will appreciate it too because it means I might not fret for a few minutes. ;-) Thanks in advance!

[leecounty]

Thanks for your comment. My blood work is now mostly back. Glucose and cholesterol numbers were in the 'ideal/best' range. My creatinine was a 58, meaning that my kidneys are even healthier than the normal 60-100 range that is hoped for. My prolactin this time was a 17 -- much different than the other clinic I was initially going to that had a 28 when the sample was taken in the late afternoon.  This time it was taken in the morning. Still awaiting the androgen tests that will come in sometime next week, but nurse of my new doctor says that it would be rather unlikely for those to be elevated if everything else pointing to PCOS is coming back with very healthy results.

It makes me wonder if all my results at the first hospital/clinic were messed up. They misdiagnosed my HYPOthyroidism as HYPER, they had me do the prolactin in the late afternoon when it would be elevated -- by 11 points!, and they thought it was just fine to let me bleed for 68 days with heavy bleeding (68 because of the new dr at the second clinic/hospital I went to putting me on Provera) and would have let me go for another month before I was to call them about it again.

[Bhupinder Kaur, MD]

Hello,
High levels of TSH indicate that the thyroid is not producing sufficient levels of thyroid hormone and hence hypothyroidism may be causing your symptoms, This has been complicated by ovarian cysts. PCOS is a problem in which a woman’s hormones are out of balance. So ovaries develop more follicles than normal every month. Diagnostic tests are 2 hr GTT, serum androgen and testosterone levels, LH-FSH ratio, prolactin levels, TSH levels,17-hydroxyprogesterone levels  and 3D ultrasound done.
Poly cystic ovarian syndrome can be treated in different ways. One of the most effective treatments is use of contraceptive pills or progesterone pills. It can also be treated surgically and this procedure is known as drilling. Try losing weight as it helps a lot to normalize menstruation.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.