Endocrine Abstracts

52 year old lady was referred to the endocrine clinic with h/o lethargy and tiredness. She also had mild tremors. She denied weight loss, palpitations or diarrhoea. Past medical history includes bipolar disorder. She was on Venlafaxine, Carbamazepine, Pregabalin and HRT. GP has done thyroid functions because of the symptoms and results are as below. TSH: 7.15 mIU/l(0.38–5.50), FT4:24.3pmol/l (10.0–18.7) on 05.02.2020 TPO:<10 IU/Ml This was rechecked in a different laboratory to eliminate assay interference and the results were comparable. TSH:7.8 mIU/l(0.38–5.50), FT4:24.9 pmol/l(10.0–18.7), FT3:7.7 pmol/l Additional investigations including a full anterior pituitary profile was also organised. The results are as below. SHBG:>180 nmol/l Alfasubunit 1.78 IU/l(<3.00) Prolactin: 411 Miu/l(0–646) LH:5.5 IU/l FSH:10.5 IU/l Cortisol:508 nmol/l IGF–1:179 mcg/l (97–292) This was followed by an MRI scan of her pituitary scan. The scan has shown presence of an adenoma measuring 11*9*6 mm solid, cystic lesion within the right side/midline of the pituitary gland with areas of hypo/hyper enhancement. TRH stimulation test was done by injecting 200mcg of TRH intravenously. The results are as below. 0 MIN:TSH 5.75, FT4:20 20 Min:6.37 60 min:6.74 This was highly suggestive of TSHoma and was discussed in local Pituitary MDT. Somatostatin analogues(SSA) were started as initial therapy and monitored response with thyroid function tests. Also referred to a regional centre for genetic testing. Thyroid functions improved after a week of SSA as below. TSH:3.96 mIU/l FT3:3.8 pmol/l FT4:12.1 pmol/l on 24.11.2021 and remained normal thereafter. Unfortunately, she couldn’t tolerate the SSA and was referred to neurosurgeons for considering surgery