Endocrine Abstracts

Cases of hyperthyroidism manifestation associated with previous secondary hypothyroidism are extremely rare. The article presents a rare clinical case of Graves’ disease manifestation in a patient with secondary hypothyroidism after radiosurgical treatment of acromegaly. A 38-year old woman with acromegaly and endo-supra-laterosellar pituitary adenoma had transsphenoidal non-radical surgery and subsequent radiosurgical treatment. After 2 years of radiation treatment, she developed secondary hypothyroidism, adrenal insufficiency, hypogonadism, growth hormone deficiency. However, 1.5 years after the diagnosed hypopituitarism the manifestation of Graves’ disease was noted, which required thyrostatic and radioactive iodine treatment. Diagnostic criteria for secondary hypothyroidism include low levels of freeT4, freeT3 with reduced, normal or slightly elevated levels of TSH. The criterion for the development of thyrotoxicosis in patients with secondary hypothyroidism was persistent increase of freeT4 and T3 levels in an adequate therapy with levothyroxine. The detection of high level of thyrotrophin receptor antibody in the described case has confirmed Graves’ disease manifestation.