For a TSH producing microadenoma, would you recommend surgery vs methimazole if the patient is elderly and the tumor is relatively small?

Topics: Endocrinology • Pituitary Disorders

The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’ve diagnosed and found the TSH adenoma and started methimazole and she is clinically much improved. Do I just follow her clinically on methimazole or send for surgical resection of the pituitary tumor?

Answer from: at Community Practice

In general, treating TSHomas with methimazole is not a good idea, as the adenoma may grow. If she is a candidate for surgery, this should probably be advised. Most TSHomas respond very well to somatostatin receptor ligands (better than GH-secreting adenomas).

Comments

at Loma Vista Endocrinology Inc
Thank you so much Dr. @Salvatori!!

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