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Recovery After Removal of the Tumor

Gabriel Dickstein, MD; David Barzilai, MD

Arch Intern Med. 1982;142(8):1544-1545.

Abstract
A 50-year-old man, suffering from a large pituitary adenoma and panhypopituitarism, was found to have severely elevated thyrotrophin (thyroid-stimulating hormone [TSH]) levels (<20.0 µU/mL). The thyroxine (T₄) level was low (<3.0 µg/dL). Thyroid sodium iodide 1131 uptake was low (5% at 24 hours). A TSH test result was normal, with a 24-hour ¹³¹I uptake of 52% and a normal-looking thyroid gland on scintiscan. After surgical removal of the pituitary chromophobe adenoma, T₄ levels returned to normal (6.8 µg/dL) and TSH levels improved substantially (9.0 µU/mL). Findings from repeated ¹³¹I uptake tests were normal (22% at 24 hours). Other pituitary functions improved also. These results suggest that the patient had biologically inactive TSH produced by the tumor. Removal of the tumor probably enabled recovery of the active TSH with the return of normal thyroid uptake and T₄ production. Whenever hypothyroidism and high levels of TSH coexist with pituitary dysfunction, a TSH test is needed to distinguish between primary hypothyroidism and hypothyroidism secondary to biologic inactive TSH.

(Arch Intern Med 1982;142:1544-1545)

Author Affiliations
From the Endocrine Institute and Department of Internal Medicine C, Rambam Medical Center; and Faculty of Medicine, Technion-Israel Institute of Technology; Haifa, Israel.

Footnotes
Accepted for publication March 11, 1982.

Reprint requests to Endocrine Institute, Rambam Medical Center, 31096 Haifa, Israel (Dr Dickstein).

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