ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Clinical case reports - Pituitary/Adrenal (41 abstracts)
1Bhaktivedanta Hospital and Research Institute, Mira Road, Thane, Maharashtra, India; 2Ashtavinayak Hospital, Borivali, Mumbai, Maharashtra, India; 3Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India.
Introduction: TSHOMAs are rare pituitary tumors with prevalence of 12 cases per million. We present a case of of TSHoma where the course was complicated by the coexistence of autoimmune hypothyroidism.
Case: 41 year old male presented with fatigue, lethargy and palpitations. On screening was found to have raised t3 216.30 ng/dl (N-70-204 ng/dl), t4 12.10 μg/dl(N-4.2-11.6 μg/dl) and TSH 27.55 uIU/ml (0.25.7 uIU/ml). Further evaluation revealed raised free t3 (FT3), free t4 (FT4) and TSH (column 1, Table 1), raised anti thyroid peroxidase antibodies and negative TSH receptor antibody, normal cortisol 10.8 μg/dl (N-5-25), testosterone 769.73 ng/dl (N-275-900), prolactin 18.89 ng/ml (525), IGF1 124 ng/ml (64210) levels. Thyroid function of first degree relations was normal. SHBG 78.20 nmol/l (N-11.2-78.1) and alpha subunit levels 3.8 ng/ml (0.10.5) were raised. TSH concentration significantly reduced 5 hours after single octride dose as well as after three doses of 100 μg octride over 24 h. MRI confirmed presence of pituitary macroadenoma 2.4×1.2×1.2 cm abutting the chiasma (visual fields normal). Patient was subjected to transsphenoidal surgery. The adenoma immunostained positive for TSH, was also positive for p53 with MIB index 35%. Patient FT3, FT4 and TSH was low 2 weeks post surgery and 25 μg thyroxine was started. Follow up report at 6 weeks showed low FT3, FT4 and raised TSH levels after which thyroxine was stepped up. Patient did not need any other hormone replacement.
Baseline | After 5 h of octride | After 3 doses of 100 μg octride | Post surgery 2 weeks | Post surgery 6 weeks | Post surgery 12 weeks | |
Free t3 (1.73.7 pg/ml) | 4.86 | 1.19 | 1.1 | 2.7 | ||
Free t4 (0.71.8 ng/ml) | 1.83 | 0.53 | 0.62 | 1.12 | ||
TSH (0.25.7 uIU/ml) | 25.5 | 13.8 | 7.6 | 0.1 | 54 | 3.82 |