case_images: PMC11408738_01
case_images: (A) Fluctuations of the levels of FT3 and FT4. (B) Fluctuations of the levels of TSH and TRAb. (C) Fluctuations of the levels of TgAb and TPOAb. (D) Fluctuations of the level of IGF-1.
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case_images: F1
case_images: The thyroid function (Figures 1A, B) and thyroid antibodies (Figures 1B, C) were abnormal. The levels of free triiodothyronine (FT3) and free thyroxine (FT4) at 1 and 2 months after the surgery reduced; however, they were still in abnormal ranges (Figure 1A). The thyroid antibodies were still positive at 1 month after the surgery (Figures 1B, C). The levels of IGF-1 (Figure 1D) and SHBG (Table 1) were downregulated, and the P1NP level reduced to 86.30 ng/ml (9.06~76.24 ng/ml), 1 month after the surgery. TSH level was reduced (Figures 1A, B). TRAb (Figure 1B) and SHBG (126.29 nmol/L, reference range: 14.55-94.64 nmol/L) were significantly upregulated. The thyroid ECT showed moderate enlargement of the thyroid gland and an increase in the uptake of radionuclides Tc-99 (Figure 4). These results indicated hyperthyroidism. TSH level was not suppressed (Figures 1A, B), and the levels of thyroid antibodies were still high 1 month later. TRAb level significantly decreased (Figure 1B). The levels of TPOAb and TgAb were in the normal ranges (Figure 1C) on 7 February 2023. The IGF-1 level improved after the administration of lanreotide (Figure 1D). The follow-up hormonal and thyroid antibody results are shown in Figures 1A-D.
case_images: Preoperative and postoperative pituitary MRI. (A) Preoperative plain scan and contrast-enhanced sagittal MRI and contrast-enhanced sagittal and coronal MRI; a lesion (19 mm x 19 mm x 15 mm) in the pituitary fossa is indicated by an arrow. (B) Contrast-enhanced sagittal and coronal MRI on the first day after the surgery; the MRI showed postoperative changes in the pituitary gland, and sphenoid hemorrhagic sinus effusion was considered. (C) Contrast-enhanced sagittal and coronal MRI at 3 months after the surgery, which showed no mass lesion in the sella turcica.
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case_images: F2
case_images: This indicated a macroadenoma (Figure 2A). The postoperative contrast-enhanced pituitary MRI showed postoperative changes in the pituitary gland, and sphenoid hemorrhagic sinus effusion was considered (Figure 2B). The MRI showed no mass lesion in the sella turcica at 3 (Figure 2C), 8, and 11 months after the surgery.
case_images: Postoperative pathology.
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case_images: F3
case_images: The postoperative pathology suggested a pituitary adenoma (Figure 3).
case_images: Thyroid ECT at 8 months after the surgery (showed moderate enlargement of the thyroid gland and an increase in the uptake of radionuclides Tc-99).
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case_images: PMC11408738_01_fmed-11-1436400-g0004.jpg
case_images: F4
case_images: TRAb (Figure 1B) and SHBG (126.29 nmol/L, reference range: 14.55-94.64 nmol/L) were significantly upregulated. The thyroid ECT showed moderate enlargement of the thyroid gland and an increase in the uptake of radionuclides Tc-99 (Figure 4). These results indicated hyperthyroidism.