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Thyroid hormone resistance and enlargement of the sella turcica during pregnancy.

Abstract A 26-year-old pregnant woman was admitted to our institution running her 30 weeks of gestation. The patient had a past history of total thyroidectomy cause of a thyroid papillary carcinoma and presented with increased supraphysiological TSH levels under 250 microg T4, while slightly hyperthyroid, from the clinical point of view. Partial resistance to thyroid replacement therapy or TSH-secreting tumour was evoked. Pituitary MRI revealed a pituitary enlargement without excluding a pituitary adenoma. To avoid further stress on pituitary a caesarean section was performed at 38 weeks of gestation. MRI 7 months later was normal, while the patient remained under high doses of T4 replacement therapy and TSH was found at the upper limits of normalcy, while T3, T4 and FTI were above normalcy.
PMID
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Authors

Mayor MeshTerms

Prenatal Diagnosis

Thyroid Neoplasms

Keywords
Journal Title archives of gynecology and obstetrics
Publication Year Start




PMID- 14648184
OWN - NLM
STAT- MEDLINE
DA  - 20031203
DCOM- 20040430
LR  - 20130520
IS  - 0932-0067 (Print)
IS  - 0932-0067 (Linking)
VI  - 269
IP  - 2
DP  - 2004 Jan
TI  - Thyroid hormone resistance and enlargement of the sella turcica during pregnancy.
PG  - 152-5
AB  - CASE REPORT: A 26-year-old pregnant woman was admitted to our institution running
      her 30 weeks of gestation. The patient had a past history of total thyroidectomy 
      cause of a thyroid papillary carcinoma and presented with increased
      supraphysiological TSH levels under 250 microg T4, while slightly hyperthyroid,
      from the clinical point of view. Partial resistance to thyroid replacement
      therapy or TSH-secreting tumour was evoked. Pituitary MRI revealed a pituitary
      enlargement without excluding a pituitary adenoma. To avoid further stress on
      pituitary a caesarean section was performed at 38 weeks of gestation. MRI 7
      months later was normal, while the patient remained under high doses of T4
      replacement therapy and TSH was found at the upper limits of normalcy, while T3, 
      T4 and FTI were above normalcy. CONCLUSION: We conclude that, in the absence of
      thyroid gland, high TSH levels due to thyroid hormone resistance could be
      erroneously attributed to a pituitary TSH secreting tumour, when associated with 
      a pregnancy-related pituitary enlargement.
FAU - Siristatidis, Charalambos
AU  - Siristatidis C
AD  - 2nd Department of Gynaecology and Obstetrics, "Aretaieion" Hospital, Athens
      University Medical School, Athens, Greece. [email protected]
FAU - Mastorakos, George
AU  - Mastorakos G
FAU - Vitoratos, Nikolaos
AU  - Vitoratos N
FAU - Gregoriou, Odysseas
AU  - Gregoriou O
FAU - Iakovidou, Helen
AU  - Iakovidou H
FAU - Salamalekis, Emmanuel
AU  - Salamalekis E
FAU - Creatsas, George
AU  - Creatsas G
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20030109
PL  - Germany
TA  - Arch Gynecol Obstet
JT  - Archives of gynecology and obstetrics
JID - 8710213
RN  - 9002-71-5 (Thyrotropin)
SB  - IM
MH  - Adenoma/blood/diagnosis/pathology
MH  - Adult
MH  - Cesarean Section
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Pituitary Neoplasms/blood/diagnosis/pathology
MH  - Pregnancy
MH  - Pregnancy Complications/blood/*diagnosis/pathology
MH  - Pregnancy Complications, Neoplastic/blood/diagnosis/pathology
MH  - Pregnancy Trimester, Third
MH  - *Prenatal Diagnosis
MH  - Sella Turcica/*pathology
MH  - Thyroid Hormone Resistance Syndrome/blood/*diagnosis/pathology
MH  - *Thyroid Neoplasms
MH  - Thyroidectomy
MH  - Thyrotropin/*blood
EDAT- 2003/12/04 05:00
MHDA- 2004/05/01 05:00
CRDT- 2003/12/04 05:00
PHST- 2002/05/23 [received]
PHST- 2002/10/22 [accepted]
PHST- 2003/01/09 [aheadofprint]
AID - 10.1007/s00404-002-0455-8 [doi]
PST - ppublish
SO  - Arch Gynecol Obstet. 2004 Jan;269(2):152-5. Epub 2003 Jan 9.

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