Hyperthyroidism in a patient with TSH-producing pituitary adenoma coexisting with thyroid papillary adenocarcinoma.
A 27-year-old woman who presented with a left thyroid nodule was found to have hyperthyroidism caused by a syndrome of inappropriate secretion of TSH. The levels of free T3, free T4 and TSH were 9.50 pg/mL, 4.05 ng/dL and 2.16 microU/mL, respectively. Magnetic resonance imaging of the head revealed a pituitary macroadenoma. The TSH response to TRH stimulation was normal and responses of other anterior pituitary hormones to stimulation tests were also normally preserved. Administration of octreotide with iodine successfully reversed hyperthyroidism prior to total resection of pituitary adenoma, which was followed by hemithyroidectomy of the left thyroid five months later. Histologically, the resected pituitary adenoma was a TSH-producing adenoma (TSH-oma) and the thyroid nodule was a papillary adenocarcinoma. Serum TSH diminished to undetectable levels immediately following pituitary adenomectomy but gradually normalized over nine months. Coexistence of a TSH-oma with thyroid cancer is very rare and only two similar cases have previously been documented. This combination raises the possibility that TSH may be involved in tumorigenesis in the thyroid gland.
Department of Medicine III, Okayama University Medical School, Japan.
M
M
Kishida
F
F
Otsuka
H
H
Kataoka
K
K
Yokota
T
T
Oishi
T
T
Yamauchi
H
H
Doihara
T
T
Tamiya
Y
Y
Mimura
T
T
Ogura
H
H
Makino
D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D000328:Adult; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology* / Q000628:therapy; D007455:Iodine / Q000627:therapeutic use; D007457:Iodine Radioisotopes; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D009378:Neoplasms, Multiple Primary; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D013670:Sodium Pertechnetate Tc 99m; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000096:biosynthesis*; D013973:Thyrotropin-Releasing Hormone; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D013973:Thyrotropin-Releasing Hormone; D013972:Thyrotropin; D007455:Iodine; D013670:Sodium Pertechnetate Tc 99m; D015282:Octreotide