Endocrine Abstracts

Background

TSHomas are a rare cause of hyperthyroidism, and account for 0.5 to 3% of pituitary tumours. Incidence=0.15 per million per year. Prevalence=1 per million. Our limited experience of this condition can result in diagnostic and treatment challenges. Here we describe a case treated surgically lead to successful outcomes

Case

35 years old female referred to our service with secondary amenorrhea for the last two years. Amenorrhea Started after her delivery. She was on oral contraception pill before her pregnancy. She had associated increased tiredness, anxiety and palpitations. She has no medical or family history of endocrinopathy. Not on any regular medications. Clinically euthyroid.No eye disease or goitre, visual fields intact to confrontation. Initial bloods revealed high free T4 and T3 with inappropriate normal TSH level. Repeated bloods in different assay showed same results. Considered to be close to a state of syndrome of inappropriate secretion of thyroid-stimulating hormone. Accordingly investigations send looking for TSHoma Vs TSH resistance hormone. Sex hormone binding globulin, Alpha-glycoprotein subunits were both elevated suggestive of TSHoma. Thyroid releasing hormone test done showed flat response. Magnetic resonance imaging showed a macropituitary tumor.Started on larenotide however she could not tolerate it, surgery performed subsequently, histology confirm TSHoma. Few weeks later her thyroid function normalized and her symptoms improved including period become regular.

Conclusion

Surgery remains the first-choice treatment for TSHoma. If surgery is successful, recurrence is rare. Our case showed an excellent outcome in typical case of TSHoma, respond very well to the surgical intervention. Surgical option is the first line, however surgical failure can be seen in 40 percent of cases.