Primary Hypothyroidism and Hyperplasia of Thyrotrophic Cells

We present a case, including history, laboratory findings and results of diagnostic imaging during a two year follow up period. A review of the pertinent literature is provided. A 40 year-old woman was referred to a neurologist for evaluation of frontal headache. Magnetic resonance imaging of the sella revealed a pituitary tumor and the patient was referred to a neurosurgeon for work up and surgery. The patient ended up in endocrinology when she became aware that the pituitary gland is an endocrine organ. The biochemical IU/l, FT3 1.91µevaluation of the anterior pituitary revealed a TSH of 243.8 pg/ml, FT4 0.45 ng/dl and anti-TPO >1000 IU/ml, the rest being within the normal range. Levothyroxine replacement therapy releaved the patient of her pertinent symptoms and caused shrinkage of pituitary hyperplasia. This case illustrate that primary hypothyroidism may be associated with pituitary enlargement. The primary care physician should consult an endocrinologist for complete evaluation in order to avoid unnecessary medical work up and surgical intervention