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. 2016 Aug 2;4(3):2324709616661834.
doi: 10.1177/2324709616661834. eCollection 2016 Jul-Sep.

Severe TSH Elevation and Pituitary Enlargement After Changing Thyroid Replacement to Compounded T4/T3 Therapy

Adlai L Pappy 2nd  1 , Nelson Oyesiku  1 , Adriana Ioachimescu  1
Affiliations

Severe TSH Elevation and Pituitary Enlargement After Changing Thyroid Replacement to Compounded T4/T3 Therapy

Adlai L Pappy 2nd et al. J Investig Med High Impact Case Rep. .

Abstract

We present the first case of iatrogenic hypothyroidism as a result of compounded thyroid hormone (T4/T3) therapy. The thyroid replacement was changed from 175 µg levothyroxine (LT4) to 57/13.5 µg compounded T4/T3 daily in order to improve the T3 level, despite normal thyroid-stimulating hormone (TSH). This resulted in clinical manifestations of hypothyroidism and high TSH level (150 µIU/mL). Six months later, the patient was referred to our clinic for abnormal pituitary magnetic resonance imaging. On reinitiating a physiologic dose of LT4, clinical and biochemical abnormalities resolved and the pituitary gland size decreased. Our case emphasizes the importance of using TSH level to gauge dose adjustments in primary hypothyroidism. Also, it underscores the current American Thyroid Association recommendation against routine use of compounded thyroid hormone therapy.

Keywords: compounded T4/T3; hypothyroidism; levothyroxine; pituitary enlargement; pituitary hyperplasia.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
MRI of the pituitary gland at presentation (May 2015) and after restoring euthyroidism (Jan 2016).
See this image and copyright information in PMC

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References

    1. Jonklaas J, Davidson B, Bhagat S, Soldin SJ. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA. 2008;299:769-777. doi:10.1001/jama.299.7.769. - DOI - PubMed
    1. Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R. Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS One. 2011;6(8):e22552. doi:10.1371/journal.pone.0022552. - DOI - PMC - PubMed
    1. Alevizaki M, Mantzou E, Cimponeriu AT, Alevizaki CC, Koutras DA. TSH may not be a good marker for adequate thyroid hormone replacement therapy. Wien Klin Wochenschr. 2005;117:636-640. doi:10.1007/s00508-005-0421-0. - DOI - PubMed
    1. Woeber KA. Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations. J Endocrinol Invest. 2002;25:106-109. doi:10.1007/BF03343972. - DOI - PubMed
    1. Pepper GM, Casanova-Romero PY. Conversion to armour thyroid from levothyroxine improved patient satisfaction in the treatment of hypothyroidism. J Endocrinol Diabetes Obes. 2014;2(3):1055.

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