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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Thyroid & pituitary issues
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.
Thyroid & pituitary issues
by oldmame, Jun 25, 2009 12:29PM
Dr. Lupo, I posted a couple years ago concerning my daughter and your advice was more insightful than you know so here I am again! My daughter (now 18) was given a shot of cortisone in '07 after a "uncommon" (according to Dr) stress fracture in her lower back. In the months that followed we feared she was panhypopituitary as her hormone levels were almost nil, although she gained 40 pounds and pronounced purple stretch marks appeared on her stomach (looked like Cushings only cortisol near 0). After a couple months of hormone replacement her lab tests came back near to normal - to this day she states she "doesn't feel right" and was put on an anti-depressant. During this time she had some imaging done and a microadenoma was found on her pituitary. She has Hashimoto's thyrotoxicosis (and antibodies for Graves) but the highest her TSH has ever been is 0.6 with low normal free T4 and T3. I thought this was indicative of a pituitary problem rather than a thyroid problem. She has developed 6 nodules on her thyroid in the last year. Our endo's plan is to test her thyroid annually, but I am concerned something else should be done. Any advice would be greatly appreciated!
Doctor's Answer
by Mark Lupo, M.D., Jun 25, 2009 09:09PM
, Jun 25, 2009 09:09PM
With the lowish TSH, T4 and T3 I share the concerns for pituitary problems. Would consider testing other pituitary hormones.
The antibodies are present for a primary thyroid problem (autoimmune thyroid disease) but this does not explain the thyroid profile currently. Observation may be the best option, but would usually repeat in 6 months.
She had exogenous (medically induced) Cushings from the steroid injection -- this sometimes takes a while to recover from and can cause the abnormal thyroid function tests. There is not a specific treatment for this, only monitoring for normal recovery of the pituitary-adrenal axis.
If the thyroid nodules are large, then FNA biopsy may be indicated but they are likely <1cm if the endo recommended observation.
The pituitary microadenoma may be a red herring as 10% of young adults have these. However testing IGF-1 (ie, for excess growth hormone) and Prolactin would be part of this evaluation.
The antibodies are present for a primary thyroid problem (autoimmune thyroid disease) but this does not explain the thyroid profile currently. Observation may be the best option, but would usually repeat in 6 months.
She had exogenous (medically induced) Cushings from the steroid injection -- this sometimes takes a while to recover from and can cause the abnormal thyroid function tests. There is not a specific treatment for this, only monitoring for normal recovery of the pituitary-adrenal axis.
If the thyroid nodules are large, then FNA biopsy may be indicated but they are likely <1cm if the endo recommended observation.
The pituitary microadenoma may be a red herring as 10% of young adults have these. However testing IGF-1 (ie, for excess growth hormone) and Prolactin would be part of this evaluation.
