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To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism. Case report. Endocrinology private practice. A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism. Administration of levothyroxine and titration of the dose. Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy. The patient was diagnosed with severe hypothyroidis