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Kim, Kim, Ryu, Nam, Lee, Koh, Sin, and Chung: A Case of Iodine-induced Thyrotoxicosis with Acromegaly
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2006; 21(1): 63-67.

Published online: 20 February 2006

DOI: https://doi.org/10.3803/jkes.2006.21.1.63

A Case of Iodine-induced Thyrotoxicosis with Acromegaly

Kwang Hyun Kim, Kyu Hong Kim, Ho Yoel Ryu, Su Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yeol Sin, Choon Hee Chung

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

Received 4 July 2005       Accepted 11 July 2005

Copyright © 2006 Korean Endocrine Society

Abstract

Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma

Keywords: Acromegaly, Pituitary adenoma, Iodine-induced thyrotoxicosis

Figures and Tables

Fig. 1
About 1 cm sized oval shaped heterogeneous signal intensity lesion along the right side pituitary gland with asymmetrical right side convex margined upper margin with slightly left located infundibulum. (A) coronal view, (B) sagittal view.
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Fig. 2
Neck sonography shows a diffuse enlarged thyroid that has heterogeneous echotexture and multiple anechoic cystic lesion below 0.5 cm sized.
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Fig. 3
(A) After injection of Tc-99m pertechnetate 5 mci, the decreased uptake of Tc-99m is noted with front visualization of thyroidal activity. (B) The uptake ratio of I-131 at 2 hours and the uptake ratio of Tc-99m pertechnetate at 20 minutes are measured 0.97% and 0.63%, respectively.
jkse-21-63-g003
Table 1
Pituitary Challenge Test
jkse-21-63-i001

ACTH, adrenocorticotrophic hormone; FSH, follicle stimulating hormone; GH, growth hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone; TSH, thyroid stimulating hormone.

Table 2
Thyroid Hormone
jkse-21-63-i002

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