This is a moderately interesting case report.
However, the reason I am posting is mostly to do with the comment that Graves (Hyperthyroidism) and hypopituitarism are not mutually exclusive. Just why would anyone ever suggest they are mutually exclusive? Entirely different mechanisms.
Just because the outcomes (high or low thyroid hormone levels) are opposite has no bearing on co-existence.
Recenti Prog Med. 2019 May;110(5):255-258. doi: 10.1701/3163.31449.
[Hyperthyroidism and hypopituitarism: two incompatible diagnoses?]
[Article in Italian]
Bertola G1, Bianchi R1, Giambona S1, Berra SA1.
Author information
1 UO di Medicina I, ASST Rhodense, Presidio Ospedaliero di Garbagnate Milanese, Milano.
Abstract
We report the case of a 67-year-old man, with a past medical history of radiotherapy for nasopharyngeal carcinoma, who presented with the classical features of a hyperthyroidism (H), due to Graves' disease, with a high TSH receptor antibodies (TRAb) titre. Thyrostatic therapy was started, with gradual improvement of the symptoms and of the thyroid function tests. Two years later, TRAb became negative and the therapy was stopped. In the following months a previously unknown anterior pituitary insufficiency became evident. Therapy with cortisone acetate, L-thyroxine and testosterone was started, resulting in prolonged normalization of the clinical picture. Six years later a short relapse of H was observed, simultaneously to a new increase of TRAb titre, requiring the transitory interruption of the L-thyroxine therapy. In a few months span H disappeared and central hypothyroidism manifested again, so that the patient is still taking replacement therapy. This case illustrates how H and hypopituitarism are not mutually exclusive diagnoses and how, even if rarely, central hypothyroidism and H could alternate in the clinical history of the same patient.
PMID: 31140459
DOI: 10.1701/3163.31449
