A pituitary tumor that secretes a hormone called thyroid-stimulating hormone (TSH) is called a thyrotropinoma (or sometimes a TSHoma). An excess of amount of thyroid hormone causes hyperthyroidism, which can be a serious medical condition.
The UCLA Pituitary Tumor Program offers comprehensive management of TSHoma. Our physicians have years of experience in diagnosing, treating and managing pituitary conditions. Because thyrotropinomas are so rare, representing just one percent to two percent of all pituitary adenomas, patients are often misdiagnosed for years. Many patients end up undergoing treatments to destroy the thyroid.
That is why it is so important to come to a recognized pituitary tumor center for proper, accurate diagnosis and treatment.
Use these links to explore more about TSHoma:
Often, patients experience the typical symptoms of hyperthyroidism. Sometimes, patients will experience mild symptoms or even none at all.
Symptoms of hyperthyroidism include:
Thyroid storm is a rare but severe complication of hyperthyroidism, requiring prompt treatment and hospitalization. Thyroid storm may occur when a thyrotoxic patient becomes very sick or physically stressed.
In addition to hyperthyroidism, you may experience symptoms including:
Rarely, patients with thyrotropinomas experience tumor mass effect, caused by large pituitary tumors (macroadenomas). In addition to the severe hormonal effects related to hyperthyroidism, the large tumor can compress adjacent structures leading to:
Increased compression of the normal gland can cause hormone insufficiency, called hypopituitarism. The symptoms depend upon which hormone is involved.
More severe hypopituitarism can lead to hypothyroidism or abnormally low cortisol levels, which may be life threatening. Symptoms of severe hypopituitarism include;
Your doctor will conduct a physical examination and ask you about your symptoms and medical history.
Diagnostic procedures include:
We use hormone tests to determine if there are elevated levels of thyroxine (T4) and thyrotropin (TSH). A neuro-endocrinologist, specializing in pituitary tumors, may be required in complex cases. Learn more about hormone testing at the UCLA Pituitary Tumor Program.
Your doctor may order a magnetic resonance imaging (MRI) of the pituitary gland to detect any tumors. We use a special MRI pituitary protocol in order to best visualize the tumor. Occasionally, a computed tomography (CT) scan may be used.
Managing thyrotropinomas can be challenging. The most effective treatments involve the care and expertise of a multidisciplinary team, with close collaboration between the neurosurgeon and the endocrinologist. Surgery is usually needed, and the hyperthyroidism must be carefully managed prior to and during surgery to prevent serious complications.
Treatment options include:
Surgically removing the tumor, or tumors, offers the best chance for a cure. The neurosurgeons at UCLA's Pituitary Tumor Program perform a high volume of pituitary surgeries each year. Our surgeons practice the latest surgical techniques, such as the expanded, endoscopic endonasal approach allowing us to surgically remove tumors that were previously considered unresectable (unable to be removed surgically).
The success of the surgery depends on a number of factors, including the expertise and experience of the operating surgeon:
Invasive and very large tumors may require additional therapy, including removal of the thyroid gland or stereotactic radiation of the pituitary tumor.
Anti-thyroid drugs are drugs that inhibit the production of thyroid hormones. These medications may take weeks to become effective. The dosage may also change over a period of months, until the optimal dosage is obtained. You will need to have regular doctor visits and blood tests to monitor the drug's effectiveness.
Examples of anti-thyroid medication include:
Some tumors cannot be removed surgically, and may not respond to medications. Radiation therapy can be effective in controlling the growth of these tumors.
We use an advanced radiation therapy technique called stereotactic radiosurgery. This carefully sculpted radiation beam is able to deliver a high dose of radiation to the target. The surrounding brain structures receive only a fraction of the radiation and are typically unharmed, with the exception of the pituitary gland.
A consequence of radiation treatment is that it can cause delayed pituitary failure. This typically occurs several years after treatment. It is important that you continue your follow-up care with an endocrinologist, who can monitor your progress and any changes. You may require hormone replacement therapy.
To schedule an appointment with one of our physicians at the Pituitary Tumor Program, please call (310) 825 5111.