Isolated Unilateral Pleural Effusion Without Ascites in Late Onset Ovarian Hyperstimulation Syndrome: A Case Report and Review of Literature

Abstract

Isolated pleural effusion is a rare presentation of severe OHSS. Two to four percent of women of reproductive age have subclinical hypothyroidism which is an uncommon association of late onset iatrogenic OHSS. This report describes an unusual patient with isolated unilateral pleural effusion and subclinical hypothyroidism as the only manifestation of late onset OHSS in a singleton pregnancy following in vitro fertilization (IVF). We have summarized current literature related to isolated pleural effusion in late OHSS and evaluated its pathophysiology and treatment options. Albumin infusion may be considered as a plasma expander whenever there is a planned third space drainage. Thyroid profile test in asymptomatic patients planning IVF will help to identify subclinical hypothyroidism. OHSS is a self-limiting condition and a timely diagnosis with aggressive management can be lifesaving.

Ovarian Hyperstimulation syndrome combined with hypothyroidism: a comprehensive review

“…However, the inability to rapidly produce thyroid hormones in patients with HT and PCOS, coupled with the accumulated high concentration of TSH, leads to the development of OHSS [58]. Additionally, HT may increase the risk of patients undergoing COH developing OHSS [9]. Furthermore, the activation of the cytokine signaling inhibitor and the dysregulation of IL-2 expression caused by high concentration of serum HCG are generally considered to be the causes of OHSS [76].…”

“…The incidence rates of OHSS vary globally. Although OHSS can occur in women with singleton or multiple pregnancies, HT, and pituitary adenomas, with or without pregnancy in very rare cases [7,8], the overall incidence rate of OHSS accounts for approximately 33% of all cycles of in vitro fertilization (IVF) cycles worldwide [9]. In China, the incidence rate of moderate and severe OHSS in women of reproductive age was 1.14% [10].…”