Ablative thyroid treatment for thyrotoxicosis due to thyrotropin-producing pituitary tumours

Abstract

Thyrotropin (TSH)-secreting pituitary adenomas (TSHomas) are rare tumours. It has been suggested that thyroid surgery or radioiodine treatment should not be considered in patients with such tumours as these treatments may facilitate rapid tumour expansion. We studied the effects of thyroid ablative treatment on tumour size and thyroid status in two patients with TSHomas. Patients studied were: (1) a female with a TSHoma who declined to undergo pituitary surgery and underwent a total thyroidectomy instead and (2) a male patient who opted for radioiodine treatment for his recurrent TSHoma. Changes in tumour size on serial magnetic resonance imaging scans, and restoration of euthyroidism were studied. No marked changes in tumour size or features of aggressiveness occurred in these patients over periods of 8 and 12 years. Euthyroidism was restored and maintained in both patients. Ablative thyroid treatment can be a safe and successful option to treat TSHomas.

Uncommon Causes of Thyrotoxicosis

“…Treatment focused on the thyroid results in continued growth of the pituitary tumor. Nevertheless, there are reports of ablation of the thyroid rather than therapy of the pituitary adenoma, but careful long-term monitoring of the pituitary is important (30).…”

Niezwykłe współwystępowanie nietypowego guza przysadki wydzielającego TSH i przewlekłej białaczki limfatycznej

“…They can co-secrete other hormones such as growth hormone (GH) or prolactin. In the hormonal diagnostics, elevated serum concentrations of thyroid hormones are accompanied by non-adequately normal or increased TSH secretion [1,2]. The therapy of choice is selective transsphenoidal adenomectomy, with neurosurgery success rates of about 40%, due to the invasiveness and the fibrous character of the tumour.…”

“…Somatostatin analogues can inhibit TSH secretion from the tumour and subsequently can lower thyroid hormones levels in 90% of cases. Sometimes symptomatic therapy with anti-thyroid drugs or radioiodine is necessary before surgery [1][2][3][4].…”