Case Report: A patient with an empty sella accompanied by rare thyrotoxicosis

Empty sella (ES) involves herniation of the pituitary fossa, leading to pituitary flattening. While typically associated with central hypothyroidism, its co-occurrence with hyperthyroidism is rarely reported and often overlooked. We report a rare case of hyperthyroidism in a patient with ES. The patient was diagnosed with ES combined with Graves' disease (GD) and Hashimoto's thyroiditis (HT). Her pituitary gland appeared flattened with a depressed upper edge. The gland height was approximately 2.3 mm. Abnormal thyroid function in this case may result from the combined effects of all three conditions. A literature search on PubMed revealed a possible association between ES and autoimmune thyroid disease; however, only seven relevant studies were identified, and no standardized diagnostic or treatment protocols exist. Hyperthyroidism may mask the diagnosis of ES. In patients whose thyroid function does not normalize with conventional oral antithyroid medication, the possibility of ES should be considered. When ES is associated with primary hyperthyroidism, antithyroid drug dosages should be lower than conventional doses. Thyroid function should be monitored more frequently, and medication dosages should be adjusted promptly.