Kulshreshtha B, Chopra A, Aggarwal A, Baxi K
"Dr. Ram Manohar Lohia" Hospital, Post Graduate Institute of Medical Education & Research - Endocrinology, New Delhi, India.
Acta Endocrinol (Buchar). 2020 Jan-Mar;16(1):90-94. doi: 10.4183/aeb.2020.90.
Thyroiditis developing post pituitary surgery in a case of TSH secreting tumor has been reported, albeit rarely. A 46 year old female was treated as a case of hypothyroidism for almost five years, however, TSH levels remained unsuppressed in spite of increasing thyroxine doses. A cyclic pattern of TSH with T3 secretion was observed after stopping thyroxine, though T4 levels were normal. T3 suppression test revealed a non suppressed TSH and MRI sella revealed a pituitary mass with Grade 1 cavernous sinus invasion. With a diagnosis of TSH secreting tumor, the patient was initiated on octreotide therapy. TFT normalized within 4 days of initiation of octreotide, tumor size reduced by about 30% within 2 months of therapy and goiter size reduced to almost half with octreotide therapy. Anti TPO levels which were initially negative became positive within a month of octreotide therapy and FNAC thyroid revealed thyroiditis. To the best of our knowledge, this is the second case report of development of thyroiditis after octreotide therapy. The immunomodulatory role of TSH and somatostatin may have a role in the development of thyroiditis in this case.
垂体手术后发生甲状腺炎的促甲状腺激素分泌瘤病例已有报道，尽管极为罕见。一名46岁女性被诊断为甲状腺功能减退症近五年，但尽管甲状腺素剂量增加，促甲状腺激素水平仍未被抑制。停用甲状腺素后观察到促甲状腺激素与三碘甲状腺原氨酸（T3）分泌呈周期性模式，尽管甲状腺素（T4）水平正常。T3抑制试验显示促甲状腺激素未被抑制，蝶鞍磁共振成像（MRI）显示垂体肿块侵犯海绵窦1级。诊断为促甲状腺激素分泌瘤后，患者开始接受奥曲肽治疗。开始使用奥曲肽4天内甲状腺功能检查（TFT）恢复正常，治疗2个月内肿瘤大小缩小约30%，奥曲肽治疗使甲状腺肿大小几乎减半。最初为阴性的抗甲状腺过氧化物酶（Anti TPO）水平在奥曲肽治疗1个月内转为阳性，甲状腺细针穿刺活检（FNAC）显示甲状腺炎。据我们所知，这是奥曲肽治疗后发生甲状腺炎的第二例病例报告。促甲状腺激素和生长抑素的免疫调节作用可能在该病例甲状腺炎的发生中起作用。
