Metastatic struma ovarii: the burden of truth.

A 58-year-old woman was found to have metastatic thyroid cancer in her liver. This was identified when she was investigated for upper abdominal pain and underwent biopsy of hepatic lesions. She had no palpable thyroid nodule and had a normal ultrasound of the thyroid. Previously, both ovaries had been removed because of tumors. The pathologic findings in one of the ovaries could not be recovered because the procedure was more than 40 years ago, when the patient was a teenager. By a process of elimination, a diagnosis of metastatic struma ovarii was established. Treatment of metastatic thyroid cancer from struma ovarii, including removal of the normal thyroid and administration of I-131, is presented.