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Unusual Causes of Thyrotoxicosis
Table 14. Unusual Causes of Thyrotoxicosis
Disorder Diagnosis Primary management
TSH-producing adenoma Pituitary MRI, alpha-
subunit to TSH ratio
Surgical removal
Struma ovarii Radioiodine uptake over
pelvis
Surgical removal
Choriocarcinoma hCG elevation in the
absence of pregnancy
Surgical removal
yrotoxicosis factitia Absence of goiter,
suppressed serum
thyroglobulin level,
decreased RAI uptake
Psychosocial evaluation
Discontinue exogenous
hormone
Functional thyroid cancer
metastases
Whole-body RAI scanning RAI ablation, embolization
and/or surgical removal
TSH-Secreting Pituitary Tumors
121. The diagnosis of a TSH-secreting pituitary adenoma should be
based on an inappropriately normal or elevated serum TSH level
associated with elevated free T
4
and total T
3
concentrations,
generally associated with a pituitary tumor on MRI or CT, and the
absence of a family history or genetic testing consistent with RTH.
(S-L)
122. Patients with TSH-secreting pituitary adenomas should undergo
surgery performed by an experienced pituitary surgeon. (S-L)
Struma Ovarii
123. Patients with struma ovarii should be treated initially with surgical
resection following preoperative normalization of thyroid hormones.
(S-L)
Choriocarcinoma
124. Treatment of hyperthyroidism due to choriocarcinoma should
include both MMI and treatment directed against the primary
tumor. (S-L)
