+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Long-standing goiter and hypothyroidism: an unusual presentation of a TSH-secreting adenoma

Long-standing goiter and hypothyroidism: an unusual presentation of a TSH-secreting adenoma

Thyroid 6(4): 329-335

A 63-year-old female patient was referred to our hospital in February 1994 for a pituitary tumor. On a previous examination, in 1973, she had a goiter, nonspecific symptoms and only an elevated serum T3. In 1984 she had become hypothyroid, her goiter had increased, serum T4 was 69 nmol/L, TSH 34.4 mU/L, and TPO antibodies were positive. Hypothyroidism due to autoimmune thyroiditis was diagnosed and she received L-T4 100 micrograms/day. In 1985 and 1986, serum TSH had decreased but remained slightly elevated, while T4 was at the upper limits of normal. From 1987 to 1989 her serum TSH rose from 9 to 20 mU/L and remained at that level for the ensuing 4 years in spite of increasing L-T4 up to 150 micrograms/day. In October 1993, after discontinuing L-T4 for 6 weeks, TSH was 23.7 mU/L, T4 170 nmol/L, 131I thyroid uptake 52%, and the CT scan showed a large pituitary tumor with suprasellar extension. On preoperative investigation TSH was 40-51 mU/L with no response to TRH or GnRH. The alpha-subunit was increased at 6.33 micrograms/L with the alpha-TSH/TSH molar ratio of 1.23. Prolactin was elevated, but plasma cortisol, FSH, and LH were low. At surgery, we found a large chromophobe adenoma with few PAS-positive granules and with immunostaining positive for TSH and prolactin. From the clinical and biological data, we can conclude that the patient had probably a TSH-secreting adenoma since the goiter was first detected. The development, however, of autoimmune thyroiditis with hypothyroidism considerably modified the presentation of the disease and may have accelerated the growth of the tumor.

(PDF emailed within 0-6 h: $19.90)

Accession: 046567260

Download citation: RISBibTeXText

PMID: 8875756

DOI: 10.1089/thy.1996.6.329

Related references

Combined thyrotroph and lactotroph cell hyperplasia simulating prolactin-secreting pituitary adenoma in long-standing primary hypothyroidism. Surgical Neurology 29(3): 218-226, 1988

Unusual presentation of a TSH-secreting pituitary adenoma. Acta Endocrinologica 129(4): 283, 1993

Periodic paralysis as an unusual presentation of autoimmune hypothyroidism with goiter. Clinical Pediatrics 48(6): 677-678, 2009

Pseudoacromegaly: an unusual presenting manifestation of long-standing undiagnosed primary hypothyroidism. Postgraduate Medical Journal 93(1104): 639-640, 2017

Unusual presentation of long-standing aortic coarctation. Vascular Medicine 16(4): 314-316, 2011

Thyrotoxic periodic paralysis in long standing graves' disease: an unusual presentation with normokalemia. North American Journal of Medical Sciences 7(3): 119-121, 2015

Hyperandrogenism due to a testosterone-secreting Sertoli-Leydig cell tumor associated with a dehydroepiandrosterone sulfate-secreting adrenal adenoma in a postmenopausal woman: case presentation and review of literature. Endocrine Practice 15(2): 149-152, 2009

Thyrotropin-secreting adenoma in a patient with primary hypothyroidism. Endocrine Practice 17(6): E135-E139, 2012

Coexistence of TSH-secreting pituitary adenoma and autoimmune hypothyroidism. Journal of Endocrinological Investigation 29(6): 555-559, 2006

Long-term outcomes of surgery and radiotherapy for secreting and non-secreting pituitary adenoma. Radiation Oncology Journal 34(2): 121-127, 2016

Primary hypothyroidism in a child simulating a prolactin-secreting adenoma. Child's Nervous System 24(12): 1505-1508, 2008

Autoimmune Hypothyroidism Coexisting with a Pituitary Adenoma Secreting Thyroid-Stimulating Hormone, Prolactin and -Subunit. Annals of Clinical Biochemistry 38(5): 566-571, 2001

Combined thyrotroph and lactotroph hyperplasia simulating prolactin secreting pituitary adenoma in primary hypothyroidism. Laboratory Investigation 56(1): 60A, 1987

Combined thyrotroph and lactotroph hyperplasia simulating prolactin secreting pituitary adenoma in longstanding primary hypothyroidism. Canadian Journal of Neurological Sciences 14(1): 99, 1987

Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and alpha-subunit. Annals of Clinical Biochemistry 38(Pt 5): 566-571, 2001