Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Medication

You are looking at 1 - 2 of 2 items for :

  • Methimazole x
Clear All
Alfredo Di Cerbo Endocrinology, ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Foggia, Italy

Search for other papers by Alfredo Di Cerbo in
Google Scholar
PubMed Close
,
Federica Pezzuto Department of Medical, Oral and Biotechnological Sciences, Dental School, University ‘G. d’Annunzio’ of Chieti-Pescara, Chieti, Italy

Search for other papers by Federica Pezzuto in
Google Scholar
PubMed Close
, and
Alessandro Di Cerbo Department of Medical, Oral and Biotechnological Sciences, Dental School, University ‘G. d’Annunzio’ of Chieti-Pescara, Chieti, Italy

Search for other papers by Alessandro Di Cerbo in
Google Scholar
PubMed Close

Summary

Graves’ disease, the most common form of hyperthyroidism in iodine-replete countries, is associated with the presence of immunoglobulins G (IgGs) that are responsible for thyroid growth and hyperfunction. In this article, we report the unusual case of a patient with acromegaly and a severe form of Graves’ disease. Here, we address the issue concerning the role of growth hormone (GH) and insulin-like growth factor 1 (IGF1) in influencing thyroid function. Severity of Graves’ disease is exacerbated by coexistent acromegaly and both activity indexes and symptoms and signs of Graves’ disease improve after the surgical remission of acromegaly. We also discuss by which signaling pathways GH and IGF1 may play an integrating role in regulating the function of the immune system in Graves’ disease and synergize the stimulatory activity of Graves’ IgGs.

Learning points:

  • Clinical observations have demonstrated an increased prevalence of euthyroid and hyperthyroid goiters in patients with acromegaly.

  • The coexistence of acromegaly and Graves’ disease is a very unusual event, the prevalence being <1%.

  • Previous in vitro studies have showed that IGF1 synergizes the TSH-induced thyroid cell growth-activating pathways independent of TSH/cAMP/PKA cascade.

  • We report the first case of a severe form of Graves’ disease associated with acromegaly and show that surgical remission of acromegaly leads to a better control of symptoms of Graves’ disease.

Taxonomy:
Clinical Overview, Gland/Organ, Thyroid, Topic, Thyroid, Hormone, GH, IGF1, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Acromegaly, Graves' disease, Hyperthyroidism, Microadenoma, Pituitary adenoma, Somatotrophic adenoma, Thyrotoxicosis, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, Italy, Diagnosis and Treatment, Signs and Symptoms, Arthralgia, Back pain, Face - coarse features, Feet - increased size, Hands - enlargement, Hyperhidrosis, Hyperthyroidism, Myxoedema, Palpitations, Tachycardia, Thyrotoxicosis, Tremulousness, Investigation, FT3, FT4, GH, GH suppression, IGF1, Immunocytochemistry, MRI, Thyroid ultrasonography, TSH, TSH receptor antibodies, Intervention, Resection of tumour, Transsphenoidal surgery, Medication, Methimazole, Octreotide, Related Disciplines, Neurology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-17-0061
Volume/Issue:
Volume 2017: Issue 1
Open access
Philip C Johnston Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, Ohio 44195, USA

Search for other papers by Philip C Johnston in
Google Scholar
PubMed Close
,
Amir H Hamrahian Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, Ohio 44195, USA

Search for other papers by Amir H Hamrahian in
Google Scholar
PubMed Close
,
Richard A Prayson Patholgy and Laboratory Medicine Institute, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio 44195, USA

Search for other papers by Richard A Prayson in
Google Scholar
PubMed Close
,
Laurence Kennedy Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, Ohio 44195, USA

Search for other papers by Laurence Kennedy in
Google Scholar
PubMed Close
, and
Robert J Weil Department of Neurosurgery and the Neurological Institute, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio 44195, USA

Search for other papers by Robert J Weil in
Google Scholar
PubMed Close

Summary

A 54-year-old woman presented with bi-temporal hemianopia, palpitations, and diaphoresis. An invasive pituitary macroadenoma was discovered. The patient had biochemical evidence of secondary hyperthyroidism and GH excess; however, she did not appear to be acromegalic. Surgical removal of the pituitary mass revealed a plurihormonal TSH/GH co-secreting pituitary adenoma. TSH-secreting adenomas can co-secrete other hormones including GH, prolactin, and gonadotropins; conversely, co-secretion of TSH from a pituitary adenoma in acromegaly is infrequent.

Learning points

  • This case highlights an unusual patient with a rare TSH/GH co-secreting pituitary adenoma with absence of the clinical features of acromegaly.

  • Plurihormonality does not always translate into the clinical features of hormonal excess.

  • There appears to be a clinical and immunohistochemical spectrum present in plurihormonal tumors.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, GH, TSH, Condition/ Syndrome, Pituitary adenoma, Plurihormonal pituitary adenoma, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, United States, Diagnosis and Treatment, Signs and Symptoms, Hemianopia, Hirsutism, Hot flushes, Obesity, Palpitations, Sweating, Investigation, ACTH stimulation, Cortisol (serum), FT4, GH, IGF1, Immunohistochemistry, MRI, Prolactin, Thyroid function, Total T3, Total T4, TSH, Intervention, Transsphenoidal surgery, Medication, Methimazole, Octreotide, Related Disciplines, Surgery, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-14-0070
Volume/Issue:
Volume 2015: Issue 1
Open access