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Increased serum thyrotropin in a subacute thyroiditis patients after incomplete removal of thyrotropin-producing pituitary adenoma.

Theassociation of subacute thyroiditis with thyrotropin-producing pitui- tary adenomahas not been reported. Wepreviously reported a case of thyrotro-pin-producing pituitary adenoma discovered as pituitary incidentaloma in this journal (1 ). After the pituitary operation, serum level of thyrotropin (2.4-2.9 mU/0, free triiodothyronine (4.8 1-6.36 pmol//) and free thyroxine (1 8.3-27.0 pmol//) becamesimilar to the preoperative level, the serum thyrotropin level was inappropriately high compared with serum free triiodothyronine and free thyroxine levels. Nofurther increase of thyrotropin after the administration of thyrotropin releasing hormonewas seen similarly to before operation (1). In April 1995, about one year after the pituitary operation, which was incom- pletely performed, symptoms of sore throat and anterior neck pain, as well as typical symptoms of hyperthyroidism such as tachycardia, weight loss, fever, diarrhea and finger tremor appeared. Serumfree triiodothyronine and free thyroxine were increased to 25.6 pmol// and 70. 1 pmol//, respectively, and the serum thyroxine level was below the detection limits (less than 0.05 mU//). CRP and ESRwere high and serum thyroglobulin level was greater than 1 ,200 pmol/ /. Thyroidal 123I-uptake during 24 hours was not measurable. From these data subacute thyroiditis was diagnosed and prednisolone treatment was started.