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Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement
The Journal of Clinical Endocrinology and Metabolism
|November 1, 1976
Summary
Thyroid hormone replacement in a patient with pituitary enlargement due to hypothyroidism paradoxically caused visual failure. This highlights the need for careful monitoring of patients with pituitary enlargement during thyroid hormone therapy.
Area of Science:
- Endocrinology
- Neuro-ophthalmology
Background:
- Longstanding untreated thyroprivic hypothyroidism can lead to pituitary enlargement.
- Pituitary enlargement in this context may not initially cause visual field defects.
Observation:
- A 34-year-old woman with untreated hypothyroidism and pituitary enlargement experienced visual failure after initiating thyroid hormone replacement.
- This visual failure, characterized by severe concentric field constriction, developed within six months of therapy.
Findings:
- Thyroid hormone replacement therapy led to paradoxical visual symptoms in a patient with pituitary enlargement.
- Elevated plasma TSH and prolactin normalized with T3 and T4 hyperreplacement prior to surgery.
- Hypophysectomy relieved the visual field constriction.
Implications:
- The findings suggest a potential imbalance between pituitary TSH content and release during thyroid hormone treatment in patients with pituitary enlargement.
- This case underscores the importance of monitoring for visual pressure symptoms in patients with pituitary enlargement secondary to hypothyroidism during thyroid hormone therapy.