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A thyrotroph tumour is a very rare pituitary tumour that secretes TSH, driving the thyroid to overactivity with a TSH level that is not suppressed. It is often mistaken for common hyperthyroidism and wrongly treated by destroying the thyroid, which makes the pituitary tumour grow. Surgery is the treatment of choice; somatostatin analogues control most of the rest.
The 2022 WHO classification places the thyrotroph tumour in the PIT1 lineage, defined by TSH-beta and GATA3 staining (Asa 2022). The European Thyroid Association guideline notes that TSH-secreting tumours are characterised by high free thyroid hormones with non-suppressed TSH, that failure to recognise them may lead to inappropriate thyroid ablation with a significant increase in pituitary tumour mass, that diagnosis rests on TSH response to T3 suppression and TRH stimulation together with imaging and genetic testing to exclude thyroid hormone resistance, and that surgery is the treatment of choice with somatostatin analogues normalising TSH in most surgical failures (ETA 2013). In 90 consecutive patients operated on between 1991 and 2013 (47 women, median age 42, range 11 to 74), 18 percent were microadenomas and 82 percent macroadenomas, microadenomas becoming more frequent recently, 23 percent invaded the cavernous sinus, 74 percent were firm or hard, and co-secretion of growth hormone or prolactin occurred (J Neurosurg 2014).
How it differs from its parent: its syndrome mimics Graves disease, so the diagnostic trap is thyroid rather than pituitary; the tumours are often fibrous and invasive, making complete resection harder; and somatostatin analogues are unusually effective medically.
How common: no incidence figure in the sources read; the rarest functioning pituitary tumour (ETA 2013).
Treatment: transsphenoidal surgery after rendering the patient euthyroid; somatostatin analogues (octreotide, lanreotide) for residual or recurrent disease; radiotherapy where medical control fails (ETA 2013; J Neurosurg 2014).
The rarest functioning pituitary tumour and a very rare cause of hyperthyroidism (ETA 2013); the largest surgical series holds 90 patients, median age 42, 82 percent macroadenomas (J Neurosurg 2014). GLOBOCAN does not count pituitary tumours.
Gliomas infiltrate along white matter and can cross the corpus callosum, medulloblastoma sits in the cerebellum, and CNS lymphoma favours deep periventricular tissue; none spread through lymph nodes.
No conventional lymphatics: gliomas spread along white matter tracts and, rarely, through cerebrospinal fluid; medulloblastoma can seed the spine.
Same organ: Lactotroph pituitary neuroendocrine tumour (prolactinoma), Somatotroph pituitary neuroendocrine tumour (acromegaly), Corticotroph pituitary neuroendocrine tumour (Cushing disease and silent corticotroph tumour), Gonadotroph pituitary neuroendocrine tumour (non-functioning adenoma), Pineocytoma and pineal parenchymal tumour of intermediate differentiation, Pineoblastoma, Papillary tumour of the pineal region, Choroid plexus carcinoma, Glioma & glioblastoma, Primary CNS lymphoma, Medulloblastoma, Paediatric low-grade glioma, Diffuse midline glioma, H3 K27-altered (including DIPG), Atypical teratoid/rhabdoid tumour (ATRT), Ependymoma, Craniopharyngioma, Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma, Brain and spinal cord tumours (all types), Astrocytoma, IDH-mutant (grades 2 to 4), Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, Paediatric high-grade glioma (excluding diffuse midline glioma), Meningioma, Brain metastases (secondary brain tumours), Vestibular schwannoma (acoustic neuroma), Central nervous system germ cell tumours (germinoma and non-germinomatous), Spinal cord tumours (intramedullary and intradural), WNT-activated medulloblastoma, SHH-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)
Transsphenoidal surgery after achieving euthyroidism; somatostatin analogues for residual disease; radiotherapy where medical control fails (ETA 2013).
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Query for this cancer: (TITLE:"Thyrotroph pituitary neuroendocrine tumour" OR ABSTRACT:"Thyrotroph pituitary neuroendocrine tumour" OR TITLE:"TSH-secreting" OR ABSTRACT:"TSH-secreting" OR TITLE:"Thyrotroph tumour" OR ABSTRACT:"Thyrotroph tumour" OR TITLE:"TSHoma" OR ABSTRACT:"TSHoma" OR TITLE:"Thyrotropin-secreting pituitary adenoma" OR ABSTRACT:"Thyrotropin-secreting pituitary adenoma" OR TITLE:"TSH-secreting pituitary tumour" OR ABSTRACT:"TSH-secreting pituitary tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Thyrotroph pituitary neuroendocrine tumour (TSH-secreting), not a curated reading list.
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