The clinical picture of sho stature with low T4 and elevated TSH suggests primary hypothyroidism. The enlarged pituitary can be explained by the feedback provided by low T4 in the blood. To rule out other choices Pituitary adenoma Can produce any hormone and if it produces TSH , then T4 should be elevated TSH Secreting pituitary tumor Both TSH and T4 should be elevated Thyroid target receptor insensitivity Autosomal dominant disorder insensitivity. Characterized by elevated thyroid hormone levels and inappropriately normal or elevated TSH. The clinical features of H(Resistance to Thyroid Hormone) can include goiter, attention deficit disorder, mild reduction in IQ, delayed skeletal maturation, tachycardia, and impaired metabolic responses to thyroid hormone. The clinical features of H can include goiter, attention deficit disorder, mild reduction in IQ, delayed skeletal maturation, tachycardia, and impaired metabolic responses to thyroid hormone