Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2014) 35 P251 | DOI: 10.1530/endoabs.35.P251

ECE2014 Poster Presentations Clinical case reports Pituitary/Adrenal (50 abstracts)

Primary hyperthyroidism following successful surgical treatment for secondary hyperthyroidism due to TSH-secreting pituitary adenoma

Izabella Czajka-Oraniec 1 , Agnieszka Baranowska-Bik 1 , Magdalena Kochman 1 , Grzegorz Zielinski 2 & Wojciech Zgliczynski 1


1Department of Endocrinology, Medical Center of Postgraduate Education, Bielanski Hospital, Warsaw, Poland; 2Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland.


Introduction: Secondary hyperthyroidism due to thyrotropin-secreting pituitary adenoma (TSHoma) is rare. Coexistence of TSHoma and primary thyroid disease that could lead to hyperthyroidism is even more unusual.

Case report: A 28-year-old female with longstanding and worsening symptoms of hyperthyroidism was admitted to the hospital. Free-T4 (32.89 pmol/l) and free-T3 (6.38 pg/ml) were elevated with moderately increased TSH level (5.997 μIU/ml) suggesting secondary hyperthyroidism. Diagnosis was confirmed by dynamic testing with TRH, that showed no rise in TSH, and MRI revealed a pituitary microadenoma. At the ultrasound thyroid volume was normal, with no nodules nor enhanced blood flow, but with decreased echogenicity and heterogeneous echotexture. Antithyroid antibodies were negative and 24 h iodine uptake was increased (76%). Somatostatin analogue, administered before transsphenoidal neurosurgery, resulted in a moderate improvement of symptoms and hormonal results. After successful tumour removal clinical and laboratory signs of hyperthyroidism resolved. However, a month after neurosurgery symptoms of thyrotoxicosis recurred with elevated fT4:32.94 pmol/l, fT3:10.17 pg/ml and suppressed TSH<0.001 μIU/ml. No eye signs, neck pain or goiter were present. Iodine uptake was low (3.5%) and thyroid was hypervascular and remarkably hypoechoic at ultrasound. TPO-ab (91.2 IU/ml) and TG-ab (10.11 IU/ml) titers increased but TR-ab were negative. We diagnosed iodine-induced hyperthyroidism in a patient with preexisting silent thyroid disease (autoimmune thyroiditis) in whom povidone-iodine antiseptic solution was used during neurosurgery. Patient was treated with thiamazole and prednisone with a prompt improvement. Five months after surgery she was well, euthyroid, with no residual adenoma on MRI and a normal response of TSH secretion in TRH test (TSH 0’:1.24 μIU/ml, 60’:7.66 μIU/ml).

Conclusions: Exposure to topical iodine-containing solutions could lead to iodine-induced thyroid dysfunction in susceptible patients with preexisting thyroid disease. In such patients with coexisting pituitary adenomas usage of iodine-based antiseptic solutions should be avoided.

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