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

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).

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

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

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