DOI: 10.12890/2015_000217
Postoperative Treatment in a Patient After Hemithyroidectomy: the Therapeutic Challenges of a Hidden Thyrotropinoma
Authors
sabine_vermeersch@hotmail.com
Keywords
Thyroid nodule, thyrotropinoma, hyperthyroidism, hemithyroidectomy, somatostatin analogues.Abstract
Objectives: We report the unusual case of a patient with a thyrotropinoma, discovered after a hemithyroidectomy for a suspicious thyroid nodule, and its therapeutic challenges.
Materials and methods: In a patient who underwent hemithyroidectomy for cold thyroid nodule, hyperthyroid symptoms persisted, despite stopping levothyroxine treatment. Further investigation was carried out through the following laboratory tests: thyroid-stimulating hormone (TSH) test; free thyroxine (fT4) test; and the thyrotropin releasing hormone (TRH) test. A pituitary magnetic resonance imaging (MRI) scan and genetic analysis was also carried out. The test results confirmed the diagnosis of a thyrotropinoma.
Results: Treatment with long-acting somatostatin analogues normalised thyroid hormones and symptoms of hyperthyroidism.
Conclusion: The diagnostic approach to the thyroid nodule should include a detailed clinical and biochemical examination. Initial biochemical evaluation by TSH alone does not allow detecting inappropriate TSH secretion that may increase the risk of thyroid malignancy. In case of a thyrotropinoma, the ideal treatment consists of combined care of central and peripheral thyroid disease.
References
- Caron P. Thyrotropin-secreting pituitary adenomas. Presse med 2009;38:107–111.
- Beck-peccoz P, Persani L, Mannavola D et al. TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab 2009;23:597-606.
- Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician 2003;67:559-66.
- Alba M, Fintini D, Lovicu RM et al. Levothyroxine therapy in preventing nodular recurrence after hemithyroidectomy: a retrospective study. J Endocrinol Invest 2009;4:330-4.
- Gasparoni P, Rubello D, Persani L et al. Unusual association between a thyrotropin-secreting pituitary adenoma and a papillary thyroid carcinoma. Thyroid 1998;8:181-183.
- Unluturk U, Sriphrapradang C, Erdogan M et al. Management of differentiated thyroid cancer in the presence of resistance to thyroid hormone and TSH-secreting adenomas: a report of four cases and Review of Literature. J Clin Endocrinol Metab 2013;98:2210-2217.
- McLeod DS, Watters KF, Carpenter AD et al. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab 2012;97:2682-2692.
- Paschke R, Hegedus L, Alexander E et al. Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol 2011;7:354-61.
- Kishida M, Otsuka F, Kataoka H et al. Hyperthyroidism in a patient with THS-producing pituitary adenoma coexisting with thyroid papillary adenocarcinoma. Endocrinol J 2000;47:731-738.
- Nguyen HD, Galitz MS, Mai VQ et al. Management of coexisting thyrotropin/growth hormone-secreting pituitary adenoma and papillary thyroid carcinoma: a therapeutic challenge. Thyroid 2010;20:99-103.
