Acromegaly and Toxic Goiter. Cure of the Hyperthyroidism and Acromegaly by Proton-Beam Partial Hypophysectomy1

Abstract

A 53-yr-old female with co-existent toxic goiter and acromegaly had serum TSH levels of 8.1 and 6.4 μU/ml with serum FT₄ of 4.9 and 3.9 ng/100 ml. Fasting hGH was 25 ng/ml and suppressed only to 17 ng/ml with oral glucose. Pituitary proton beam therapy cured the acromegaly (fasting hGH 9 ng/ml and 2 ng/ml one hr post-glucose). The hyperthyroidism resolved without other therapy (FT₄ 1.9–2.4 ng/100 ml) and TSH was reduced to 3.0–4.6 μU/ml. Excessive TSH secretion appeared to cause the hyperthyroidism.