TSH secreting adenoma: a rare cause of severe head ache

31 years old male patient admitted to the emergency department because of recurrent severe head aches which continued for two years. The patient has been consulted our clinic of internal medicine because of thyroid function abnormalities. Laboratory investigations revealed elevated serum TSH of 8,6 mU/L (normal range (N); 0.34-5,6), free T4 (fT4) of 1,73 (N;0,61-1,12ng/dl), and free T3(fT3) of 5,48 (N; 2,5-3,9pg/mL). Other laboratory parameters were normal. Physical examination revealed stage 3 goiter. The other system examinations were normal. We have learned that two years ago brain computed tomography scan was performed due to head a cheand result was reported as normal. Considering secondary hyper thyroidism pituitary MR was performed. Pituitary MR revealed a 13x18 mm macro adenoma (Figure). The patient under went transphenoidal surgery. Final diagnosis wasTSH secreting adenoma after pathological examination. After surgery head a cheand hyperthyroidism were recovered.