A 44-year-old @entity1 presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0.15-3.5)mU/L and a low normal total @entity1955 (T4) of 86 (reference range 60-145)nmol/L. She was rendered symptom free on a dose of 150 microg of @entity1955 per day. However, her TSH failed to return to normal, and following a further increase in her @entity1955 dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14mU/L, free T4 (fT4) 28 (normal = 10-27)pmol/L and free T3 (fF3) 10 (normal = 4.3-7.6)pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60-390)mU/L. @entity5 was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The @entity5 was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting @entity652 . Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and alpha-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant @entity5 ; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with @entity12012 . We believe the combination of pathologies reported here is unique.

XXXX coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and alpha-subunit.

@entity1 :: ('9606', 'Species') :: ['woman'] @entity5 :: ('MESH:D009369', 'Disease') :: ['residual tumour', 'A pituitary tumour', 'tumour'] @entity1955 :: ('MESH:D013974', 'Chemical') :: ['thyroxine'] @entity12012 :: ('MESH:C562768', 'Disease') :: ['autoimmune hypothyroidism'] @entity652 :: ('MESH:D000236', 'Disease') :: ['adenoma']
@entity12012 :: (MESH:C562768,Disease) :: ['Autoimmune hypothyroidism']
