Pituitary tuberculoma is extremely rare, even in endemic regions of tuberculosis and much less frequently as a presentation of pituitary apoplexy. We describe a 25-year-old female presented with sudden onset of headache and vision loss of left eye which mimicking symptoms of pituitary apoplexy. MRI of the pituitary gland showed a rim-enhancing lesion at the intrasellar region extending into the suprasellar area, but absence of posterior bright spot with enhancement of the pituitary stalk. Pituitary hormonal evaluation revealed panhypopituitarism and diabetes insipidus. An urgent transphenoidal surgery of the pituitary gland was undertaken for which the histopathology showed necrotizing granulomatous inflammation with infarcted adjacent pituitary tissue. Despite negative fungal and AFB staining, pituitary tuberculoma was presumptively diagnosed based on imaging, pathology and the high incidence of tuberculosis in the country. After the course of anti-tuberculosis therapy, the clinical findings were dramatically improved, supporting the diagnosis. Pituitary tuberculoma is extremely rare in particular with an apoplexy-like presentation but should be one of the differential diagnosis list of intrasellar lesions in the patient presenting with sudden onset of headache and visual loss. The presence of diabetes insipidus and thickened with enhancement of pituitary stalk on MRI were very helpful in diagnosing pituitary tuberculosis.

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Bisphenol A (BPA) is a chemical that is used in a variety of consumer products, and exposure to BPA is widespread among the general population. Recent studies have suggested that BPA may affect the thyroid and related pathways. However, human studies are still limited. The aim of this study was to determine the relationship between BPA exposure and thyroid function. We obtained survey data and blood samples from The Thai National Health Examination Survey IV 2009, a nationally representative cross-sectional survey using a multistage, stratified sampling of the Thai population. A total of 2,340 subjects aged 18-94 years were sampled for the present study. Serum BPA, TSH, FT4, and related covariates were measured. BPA was log-transformed prior to analysis. BPA was detected in 52.8 % of serum samples with a median concentration of 0.33 (range 0-66.91) ng/mL. We excluded subjects who tested positive for thyroid autoantibody and then stratified the remaining subjects by gender; the analysis showed a significantly negative correlation between serum BPA and FT4 levels in males (r = -0.14, P < 0.001). In contrast, no association was observed in females. BPA was not associated with TSH in either gender. This gender-related discrepancy is possibly related to androgen-related differences in the metabolism of BPA. Our preliminary results provide evidence of a negative association between BPA and FT4 levels. Additional detailed studies are needed to investigate the temporal relationship and potential public health implications of such an association.

BackgroundThe measurement of free thyroid hormone, instead of the total form, is more commonly used in current practice. We aimed to evaluate the usefulness of the ratio of serum free triiodothyronine (FT3, pg/mL) to free thyroxine (FT4, ng/dL) for differentiating Graves' disease from subacute thyroiditis.Materials and methodsMedical records of thyrotoxic patients aged >15 years who had measurement of FT3, FT4 and thyrotropin on the first diagnosis of thyrotoxicosis before initiating treatment were retrospectively reviewed. Data were collected from all clinics, and were not limited to the endocrine clinic. Pregnant women were excluded.ResultsA total of 548 patients (468 with Graves' disease, 40 with subacute thyroiditis and 40 with toxic adenoma/multinodular goiter) were recruited. Mean age was 43.9 ± 15.4 years. Most were female 434 (79.2%), and goiter was present in 55.3%. Prevalence of T3-toxicosis and T4-toxicosis were 5.6% and 6.6%, respectively. Mean FT3/FT4 ratios were 4.62 ± 2 (10−2 pg/ng) in patients with Graves' disease and 2.73 ± 0.5 in subacute thyroiditis. The area under the ROC curve of the FT3/FT4 ratio for diagnosis of Graves' disease was 0.83 (95%CI, 0.76–0.91). Cutoff level of this ratio >4.4 offered sensitivity of 47.2% and specificity of 92.8%.ConclusionsFT3/FT4 ratio of >4.4 (10−2 pg/ng) may help in differentiating the cause of thyrotoxicosis.

TSHR and TPO gene mutations were identified alone and together in individuals of a consanguineous kindred. Homozygotes for the TSHR and a compound heterozygote for the TPO mutations were hypothyroid. The mild hyperthyrotropinemia of heterozygotes for the mutant TSHR allele was not aggravated by the coexistence of a TPO defect in one allele.

The reference interval for TSH needs to be derived from each specific population. Slightly elevated TSH concentrations in the elderly could be considered acceptable, with no need for thyroxine treatment.

Background: An increased or normal serum TSH concentration, despite elevated thyroid hormone levels, is observed in resistance to thyroid hormone (RTH) and TSH-secreting adenomas (TSHomas). When coexistent with a differentiated thyroid cancer (DTC), maintenance of a suppression of TSH is challenging.

Only a single measurement of iPTH4hr could be helpful in identifying patients at risk of significant immediate hypocalcemia in need prompt treatment, and subsequently facilitating early discharge of patients. Also, this parameter can precisely predict permanent hypoparathyroidism.