@entity1378 caused by a pituitary thyrotrophin-secreting @entity5 with excessive secretion of thyrotrophin-releasing hormone and subsequently followed by @entity2743 in a middle-aged XXXX .

@entity1 @entity2847 @entity7831 @entity308 @entity2743 @entity5 @entity1955 @entity1378 @entity4090 @entity1218 @entity6145 @entity21696 @entity1954
A 46-year-old @entity1 had signs of @entity2743 and @entity21696 . Serum immunoreactive TSH and its alpha-subunit increased in the presence of high serum @entity1954 (T3), @entity1955 (T4), and free T4 concentrations, whereas beta-subunit TSH was undetectable. Exogenous @entity1218 failed to increase serum TSH. Serum TSH was markedly suppressed by glucocorticoid, but was increased by antithyroid drug. L-Dopa or @entity2847 partially suppressed, but @entity7831 had no influence on serum TSH. Serum prolactin (Prl) was above normal and markedly increased by @entity1218 , but @entity308 by @entity2847 and not suppressed by @entity7831 . Plasma @entity1218 was normal in the @entity1378 state, but was increased by glucocorticoid and antithyroid drug. Excess thyroid hormone @entity308 plasma @entity1218 concentrations. Basal serum GH levels were constantly low. @entity5 normalized serum hormones (T3, T4 free T4, @entity4090 ), and eradicated the clinical signs of @entity1378 and @entity21696 . Histological study of the @entity5 tissue demonstrated both thyrotrophes and somatotrophes. A reciprocal relationship between serum TSH and T4 concentrations shifted to a higher level before but was normalized after @entity5 . Ten months later, the clinical signs of @entity2743 and the increase in serum @entity6145 recurred without a concomitant increase in serum TSH and its alpha-subunit. Thyroidal auto-antibodies were slightly positive, but thyrotrophin-binding inhibitor immunoglobulin (TBII) was negative. Administration of antithyroid drug produced a euthyroid state, but 3 years later, discontinuation of the treatment resulted in recurrent @entity1378 without suppressed plasma @entity1218 and with no evidence of regrowth of the @entity5 . It is suggested that the @entity1 initially had @entity1378 owing to excessive TSH secretion from the @entity5 caused by abnormal @entity1218 secretion, and subsequently had @entity1378 owing to @entity2743 .
