Thyrotropinoma and multinodular goiter: A diagnostic challenge for hyperthyroidism

Thyroid disorders are frequently encountered. the diagnosis is straightforward unless clinical or laboratory findings are inconclusive and/or perplexing. hyperthyroidism due to a thyrotropin-secreting pituitary adenoma rarely occurs and symptoms due to thyroid hormone excess are subtle. the presentation of the disease becomes unusual when co-secretion of other hormones with thyrotropin or concomitant thyroid parenchymal pathology exist. we present the case of a 63-year-old female patient with thyrotropinoma co-secreting growth hormone and multinodular goiter. she developed hyperthyroidism first due to thyrotropinoma and later due to a toxic nodule. herein, we discuss the diagnostic and therapeutic challenges of hyperthyroidism with atypical presentation.