A young lady with symptoms of hypehyroidism with elevated T4 and TSH levels were 8.5. Fuher examination reveals bitemporal hemianopia. Next step of management:
Sta antithyroid drugs, and do urgent MRI brain
Sta beta-blockers
Conservative management
Sta antithyroid drugs and wait for symptoms to resolve.
Ans: A. Sta antithyroid drugs, and do urgent MRI brain(Ref Harrison 19/e p2274. 18/e p2880; Sabiston 20/e p982, 19/e p1890; Schwaz 10/e p1533, 9/e p1541: Bailey 27/e p8 1 1, 26/e p614-616)Hypehyroidism with elevated T4 and TSH levels and bitemporal hemianopia is highly suggestive of TSH-secreting adenoma.MRI - Confirm TSH-secreting pituitary adenoma diagnosis.TSH producing macroadenomas:Rare.Often large & locally invasive.Along with thyroid goiter & hypehyroidism, reflecting TSH overproduction.Diagnosis:Elevated serum free T4 levels.Inappropriately normal or high TSH secretion.MRI - Evidence of pituitary adenoma.