A subtle initial clinical presentation of a TSH-secreting PitNET

TSHomas are mostly diagnosed as macroadenomas in the context of central hyperthyroidism and/or mass-effect central symptomatology. The classical pattern of central hyperthyroidism consists of elevated free thyroid hormones and inadequately normal or slightly increased TSH. If a TSHoma is suspected, the differential diagnosis of thyroid hormone resistance (RTH) must be excluded. Surgical resection is the first-line choice of therapy for TSHomas. In cases of non-operable lesions or postoperative residual tumors, pituitary fractionated stereotactic radiotherapy, radiosurgery, and/or medical treatment with somatostatin analogs can be considered as alternatives. The management of TSHomas must happen in an interdisciplinary way.