PMC7424009_01
Radiology imaging of the patient and immunostaining for TSH in the pituitary tumor. (A) Preoperative magnetic (MR) resonance image (T1-weight, sagittal view). White arrow pointing to a less enhanced area in the sella (17 x 15 mm, arrow), involving the cavernous sinuses. (B) Preoperative magnetic (MR) resonance image (T1-weight, coronal view). (C) Postoperative MR image (T1-weight, sagittal view). (D) Thyroid ultrasound revealed a heterogenous parenchyma with rich blood flow and a nodule (ACR TR 3) located in the left lobe. The right thyroid lobe measures 5.00 x 1.70 x 1.87 cm. The thyroid isthmus measures 0.23 cm in AP dimension. The left thyroid lobe measures 5.08 x 1.77 x 1.97 cm. (E) Radionuclide (99mTcO4) scan showed diffusely increased uptake, the ratio of uptake of the tracer in the thyroid to that in the background was 45 (right lobe) and 40 (left lobe). (F) Positive immunostainning for TSH in the pituitary tumor (magnification 400 x).
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F1
Magnetic resonance imaging (MRI) displayed a less enhanced area in the sella (17 x 15 mm), involving the cavernous sinuses (Figures 1A,B). Increased blood flow in the thyroid was detected in ultrasound, with a nodule (ACR TR 3) located in the left lobe (Figure 1D). Radionuclide scan (99mTcO4) showed diffusely increased uptake (Figure 1E). Scientific, Fremont, CA, USA) (Figure 1F), whereas negative staining for ACTH, GH or PRL. TRAb and TSAb was declined to 3.57 and 1.45 IU/l. The MRI did not show any sign of tumor regrowth (Figure 1C).
Changes of TSH, FT3, FT4, and TRAb. Propranolol was prescribed on May 22, 2019. The operation was performed on July 4, 2019, and the methimazole was started on August 2, 2019. TSH, thyroid-stimulating hormone; FT3, free triiodothyronine; FT4, free thyroxine; TRAb, TSH receptor antibodies.
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F2
TSH was 0.0765 mIU/l, TRAb was 6.11 IU/l and TSAb was 5.58 IU/l (Figure 2). This was supportive for an untreated GD. TSH increased to 0.1258 mIU/l (Figure 2).