Clinical characteristics and thyroid hormone dynamics of thyrotropin-secreting pituitary adenomas at a single institutio
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ORIGINAL ARTICLE
Clinical characteristics and thyroid hormone dynamics of thyrotropin-secreting pituitary adenomas at a single institution Akira Taguchi
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Yasuyuki Kinoshita1 Fumiyuki Yamasaki1 Kazunori Arita2 Atsushi Tominaga3 ●
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Received: 11 August 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Thyrotropin-secreting pituitary adenomas (TSPA) are extremely rare pituitary adenomas; their perioperative thyroid hormone dynamics have not been completely elucidated. Here, we investigated the clinical characteristics, perioperative findings, and thyroid hormone dynamics of TSPA at a single institution. Methods We enrolled 11 patients who underwent transsphenoidal surgery (TSS) for TSPA during 2005–2019 at Hiroshima University Hospital (TSPA group) and 24 patients who underwent TSS for nonfunctioning pituitary adenomas (NFPA) in 2019 (NFPA group; for comparison). Their clinical characteristics, operative findings, and thyroid hormone dynamics, including serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were retrospectively analyzed. Results The NFPA group demonstrated a slight temporary decrease in serum TSH/ FT3/ FT4 levels on day 1 postoperatively and improvement in the levels on day 4 postoperatively. In contrast, the serum TSH level in the TSPA group demonstrated a marked decrease on day 1 postoperatively but improved on day 7 postoperatively. The serum FT3 level was also markedly decreased on day 1 postoperatively but remained within the normal range. The serum FT4 level revealed a gradual decrease until day 21 postoperatively and then recovered within the normal range 3 months postoperatively. There was no significant difference in the frequency of decline in serum FT4 level between the two groups; no patients required thyroid hormonal replacement 3 months postoperatively. Conclusions Despite a variable degree of transient hypothyroidism, all patients had a normal thyroid function after 3 months follow-up. Keywords Thyroid hormone dynamics Thyrotropin-secreting pituitary adenomas Transsphenoidal surgery Hormonal replacement ●
Introduction Thyrotropin-secreting pituitary adenomas or thyroidstimulating hormone (TSH)-secreting pituitary adenomas (TSPA) are characterized by the presence of syndrome of
* Akira Taguchi [email protected] 1
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima 734-8551, Japan
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Department of Neurosurgery, Izumi Regional Medical Center, Izumi, Japan
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Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan
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inappropriate secretion of TSH (SITSH), which indicates a clinical state of inappropriately elevated TSH secretion in the presence of elevated free thyroid hormones. In total, 67–83% of all patients manifest palpitations, tachycardia, and excessive sweating (hyperthyroidism
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