Уважаемые пользователи!

Данный сайт содержит информацию для людей с медицинским образованием и специалистов здравоохранения.
Входя на сайт, Вы подтверждаете свое согласие с Условиями использования и Политикой конфиденциальности.

Dear visitor!
This site contains medical information for healthcare professionals.
You can go further, if you agree with Terms and Conditions and Privacy Policy on this site.

Manifestation of Graves’ disease, resulting from radiosurgical treatment of acromegaly, in a patient with panhypopituitarism

Cover Page
Open Access Open Access
Restricted Access Subscription Access


Cases of thyrotoxicosis associated with a previous case of secondary hypothyroidism are extremely rare. This article presents a rare clinical case of Graves’ disease manifestation in a patient with secondary hypothyroidism after radiosurgical treatment of acromegaly. A 38-year old woman presented with acromegaly and endo-supra-laterosellar pituitary adenoma. After non-radical removal of the pituitary adenoma, radiosurgical treatment of the of the residual tissue of the pituitary tumor in the cavernous sinus area was performed. After 14 months of radiation therapy, the acromegaly was in remission; after 24 months of radiation therapy, panhypopituitarism developed (secondary hypothyroidism, adrenal insufficiency, hypogonadism, and growth hormone deficiency). Furthermore, 1.5 years after the panhypopituitarism was diagnosed, the manifestation of Graves’ disease was also noted, requiring thyrostatic and radioactive iodine treatments.

Diagnostic criteria for secondary hypothyroidism are low levels of the thyroid hormones free T4 and free T3, with a reduced, normal or slightly elevated level of thyroid stimulating hormone (TSH). The criterion for the development of thyrotoxicosis in the context of the secondary hypothyroidism was the persistent increase in the level of free T4 despite adequate drug therapy with levothyroxine. In the case report, the patient’s diagnosis of Graves’ disease was confirmed by the presence of a high level of antibodies to the TSH receptor.

Ludmila I. Astafyeva

N.N. Burdenko national medical research center of neurosurgery

Author for correspondence.
Email: last@nsi.ru
ORCID iD: 0000-0003-4480-1902
SPIN-code: 4209-4723

Russian Federation, 16, 4-ya Tverskaya-Yamskaya street, Moscow, 125047


Pavel L. Kalinin

N.N. Burdenko national medical research center of neurosurgery

Email: pkalinin@nsi.ru
ORCID iD: 0000-0001-9333-9473
SPIN-code: 1775-7421

Russian Federation, 16, 4-ya Tverskaya-Yamskaya street, Moscow, 125047


Tatyana A. Kienia

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: tatyana2336@yandex.ru
ORCID iD: 0000-0001-9205-8979
SPIN-code: 9309-0178

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992


Valentin V. Fadeyev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: walfad@mail.ru
ORCID iD: 0000-0002-2504-7468
SPIN-code: 6825-8417

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, Professor

  1. Persani L, Bonomi M. Uncertainties in endocrine substitution therapy for central endocrine insufficiencies: hypothyroidism. Handb Clin Neurol. 2014;124:397-405. doi: https://doi.org/10.1016/B978-0-444-59602-4.00027-7
  2. Price A. Screening for central hypothyroidism is unjustified. BMJ. 2001;322(7289):798-798. doi: https://doi.org/10.1136/bmj.322.7289.798
  3. Feldt-Rasmussen U, Klose M. Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients. Endocrine. 2016;54(1):15-23. doi: https://doi.org/10.1007/s12020-016-1047-x
  4. Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab. 2008;4(12):683-694. doi: https://doi.org/10.1038/ncpendmet0995
  5. Grunenwald S, Caron P. Central hypothyroidism in adults: better understanding for better care. Pituitary. 2015;18(1):169-175. doi: https://doi.org/10.1007/s11102-014-0559-8
  6. Constine LS, Woolf PD, Cann D, et al. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med. 1993;328(2):87-94. doi: https://doi.org/10.1056/NEJM199301143280203
  7. Snyder PJ, Fowble BF, Schatz NJ, et al. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med. 1986;81(3):457-462. doi: https://doi.org/10.1016/0002-9343(86)90299-8
  8. Глушаков Р.И., Козырко Е.В., Соболев И.В., и др. Заболевания щитовидной железы и риск возникновения нетиреоидной патологии. // Казанский медицинский журнал. – 2017. – Т. 98. – №1. – С. 77-84. [Glushakov RI, Kozyrko EV, Sobolev IV, et al. Thyroid diseases and risk of non-thyroidal pathology. Kazan medical journal. 2017;98(1):77-84. (In Russ.)] doi: https://doi.org/10.17750/KMJ2017-77
  9. Fajans SS. Hyperthyroidism in a patient with postpartum necrosis of the pituitary: case report and implications. J Clin Endocrinol Metab. 1958;18(3):271-277. doi: https://doi.org/10.1210/jcem-18-3-271
  10. Gurling KJ, Baron DN, Smith EJ. Thyroid adenomas and thyrotoxicosis in patients with hypopituitarism following hypophysectomy. J Clin Endocrinol Metab. 1959;19(6):717-725. doi: https://doi.org/10.1210/jcem-19-6-717
  11. Taunton OD, Pittman JA, Jr. Hyperthyroidism Following Secondary Hypothyroidism. J Clin Endocrinol Metab. 1964;24:934-938. doi: https://doi.org/10.1210/jcem-24-9-934
  12. Otsuka F, Ogura T, Hayakawa N, et al. Manifestation of Primary Hyperthyroidism after Pituitary Adenomectomy: A Case Report. Endocr J. 1997;44(6):887-893. doi: https://doi.org/10.1507/endocrj.44.887
  13. Foppiani L, Ruelle A, Cavazzani P, Del Monte P. Hyperthyroidism unmasked several years after the medical and radiosurgical treatment of an invasive macroprolactinoma inducing hypopituitarism: a case report. Cases J. 2009;2:6449. doi: https://doi.org/10.4076/1757-1626-2-6449
  14. Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly-meta-analysis and systematic review. PLoS One. 2014;9(2):e88787. doi: https://doi.org/10.1371/journal.pone.0088787
  15. Gheorghiu ML. Updates in outcomes of stereotactic radiation therapy in acromegaly. Pituitary. 2017;20(1):154-168. doi: https://doi.org/10.1007/s11102-016-0783-5
  16. Katznelson L, Laws ER, Jr., Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951. doi: https://doi.org/10.1210/jc.2014-2700
  17. Di Cerbo A, Pezzuto F, Di Cerbo A. Growth hormone and insulin-like growth factor 1 affect the severity of Graves’ disease. Endocrinol Diabetes Metab Case Rep. 2017;2017. doi: https://doi.org/10.1530/EDM-17-0061
  18. Alexopoulou O, Beguin C, De Nayer P, Maiter D. Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients. Eur J Endocrinol. 2004;150(1):1-8. doi: https://doi.org/10.1530/eje.0.1500001
  19. Beck-Peccoz P, Persani L. Variable biological activity of thyroid-stimulating hormone. Eur J Endocrinol. 1994;131(4):331-340. doi: https://doi.org/10.1530/eje.0.1310331
  20. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. doi: https://doi.org/10.1089/thy.2014.0028

Supplementary files

There are no supplementary files to display.


Abstract - 397

PDF (Russian) - 5

Remote (Russian) - 52



Copyright (c) 2019 Astafyeva L.I., Kalinin P.L., Kienia T.A., Fadeyev V.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.