A young lady presents with tremors, diarrhea and elevated T4. TSH levels were 8.5 m lU/L. Fuher examination reveals bi-temporal hemianopia. What is the next step of management?
Correct Answer: Sta anti-thyroid drugs, and do urgent MRI Brain
Description: The clinical setting of high TSH and T4 with tremors and diarrhea signifies hypehyroidism due to either a TSH secreting pituitary tumor (secondary hypehyroidism) or elevated TRH secretion from hypothalamus (teiary hypehyroidism). But the presence of "Bi-temporal hemianopia" localizes the lesion to Pituitary mass compressing the optic chiasma. Hence, the diagnosis is most likely TSH secreting Pituitary Adenoma. Radioiodine or anti-thyroid drugs can be used to control thyrotoxicosis and do urgent MRI to confirm the diagnosis. A combination of trans-sphenoidal surgery, sella irradiation, and octreotide may be required to normalize TSH, because many of these tumors are large and locally invasive at the time of diagnosis.
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