Screening the Thyroid before Initiating Treatment for Acromegaly? | Chapter 06 | Current Trends in Medicine and Medical Research Vol. 4
Aim:
To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize
the relevance of screening the screening the thyroid before initiating
treatment for thyrotoxicosis.
Presentation
of the Case: A 55-year-old lady presented with palpitations,
and weight loss of two months’ duration. She also noted her fingers and toes
had swollen up, inability to incise properly since two years. Upon examination,
she had morphological features clinically diagnostic of acromegaly. Her thyroid
was enlargedwas on investigation found to have biochemical evidence of thyrotoxicosis.
Fine needle aspiration cytology
of the thyroid
yielded colloid goiter.
Insulin like growth
factor-1 was elevated. Serum
growth hormone after
an oral glucose
tolerance test was
elevated. Magnetic resonant
imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size
11X10X12 mm at the pituitary region with delayed contrast enhancement
suggestive of pituitary adenoma. Patient was started on anti-thyroid
medications and referred to higher centre, and is awaiting surgery for
pituitary adenoma.
Discussion:
Among patients with acromegaly the incidence of thyroid diseases is around 78%
and it has the most
common presentation being
nodular thyroid disease
as the initial
presentation. It is uncommon
to see patients
presenting with symptoms
of thyrotoxicosis initially,
who had florid morphological features of acromegaly.
The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly. Goiters
seen in acromegaly
were euthyroid or autonomous, are
due to the
elevated growth hormone levels
independent of TSH
action. In about
13 to 17%,
thyroidectomies were performed
before acromegaly was diagnosed. When patients with acromegaly presents with a
weight loss should arouse the possibilities of thyroid cancer or
hyperthyroidism.
Conclusion:
Screening the thyroid is important,
as inadvertent thyroidectomies were
performed before acromegaly was diagnosed. When acromegaly co-exists
with thyroid dysfunction, the burden of cardiovascular abnormality should be
addressed especially, to reduce the morbidity and mortality rate.
Author(s) Details
Dr. C. Rajasekharan
Department of Medicine,
Medical College Hospital, Thiruvananthapuram, Kerala, 695011, India.
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