J Korean Soc Endocrinol.  2005 Jun;20(3):261-267. 10.3803/jkes.2005.20.3.261.

The Change of Thyroid Hormone by Short-term Antithyroid Drug Treatment for Preoperative Euthyroidism in TSH-secreting Pituitary Adenoma

• Lee MH
• Park JH

• KMID: 2200566
• DOI: http://doi.org/10.3803/jkes.2005.20.3.261

Abstract

Preoperative euthyroidism is needed to minimize the risk of intraoperative and postoperative complications, such as thyroid storm by surgery. Antithyroid drugs or steroid hormones are commonly used in primary hyperthyroidism for euthyroidism. However, there is no definite consensus for the preoperative management of a TSH secreting pituitary adenoma for the restoration of euthyroidism. Antithyroid drugs are not used for long-term the management of a TSH secreting pituitary adenoma, as they may cause rapid growth and greater invasiveness of the tumor due to a feedback mechanism, but they can be used for short-term management before neurosurgery. We experienced one case of a TSH secreting pituitary adenoma, which showed rapid free thyroid hormone increase due to the short term administration of antithyroid drugs for only 10 days. A somatostatin analogue, octreotide at a dose of 0.1mg, twice a day, was then tried. About 4 weeks later, her serum TSH and free T4 had normalized, with a concomitant clinical improvement. She subsequently underwent an uncomplicated trans-sphenoidal resection of the pituitary adenoma. Antithyroid drugs can induce a rapid thyroid hormone increase, but can only be used for a short-term period, so they should be administered with caution or their use reconsidered

MeSH Terms

Antithyroid Agents
Consensus
Hyperthyroidism
Neurosurgery
Octreotide
Pituitary Neoplasms*
Postoperative Complications
Somatostatin
Thyroid Crisis
Thyroid Gland*
Thyrotropin
Antithyroid Agents
Octreotide
Somatostatin
Thyrotropin

Figure

• 

  Fig. 1 Preoperative sellar MRI. (A) 12.1x8.6mm sized mass in sellar and suprasellar area in T2 weighted enhanced sagittal section image. (B) 10.6×11.5 mm sized mass in sellar and suprasellar area in T2 weighted enhanced coronal section image.

• 

  Fig. 2 (A) Free T4 levels during PTU administration (normal range 94~250 nmol/L) (B) TSH levels during PTU administration (normal range 0.17~4.05 mU/L).

• 

  Fig. 3 (A) Free T4 levels during octreotide treatment. (B) TSH levels during octreotide treatment.

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  Fig. 4 Histological examination and immunohistochemical stain of tumor tissue. (A) Hematoxylin & eosin staining of tissue shows chromophobe adenoma of solid type (×100). (B) Immunohistochemical stain of tumor shows positive staining with antibodies to TSH (×200).

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  Fig. 5 Postoperative sellar MRI. (A) T1 weighted enhanced sagittal section image. (B) T1 weighted enhanced coronal section image.

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