Редкие формы тиреотоксикоза: тиреотропин-секретирующие аденомы гипофиза

Тиреотоксикоз, чаще всего, возникает из-за аутоиммунных заболеваний щитовидной железы или многоузлового токсического зоба. Однако иногда он может быть вызван ТТГ-секретирующими аденомами гипофиза (ТТГ-омами). При наличии ТТГ-ом, уровень циркулирующих свободных Т3 и Т4 повышается на фоне отсутствия подавления или даже при повышенном уровне ТТГ. Неправильная трактовка результатов исследования с определением только уровня ТТГ может привести к ошибочному диагнозу и тактике ведения пациента, включая ненужные операции или проведение терапии радиоактивным йодом, что может способствовать увеличению размера гипофизарной опухоли. При диагностике ТТГ-ом были испробованы различные тесты, включая стимулирующие и ингибирующие, однако диагностическая ценность ни одного из них не доказана. Лишь лабораторные данные в сочетании с МРТ гипофиза, помогают правильно поставить диагноз и назначить соответствующее лечение. При выборе метода лечения ТТГ-ом предпочтение отдается хирургической транссфеноидальной аденомэктомии. В случаях, когда операция невозможна или неэффективна, методом нормализации уровня ТТГ является назначение аналогов соматостатина. В ряде случаев, возможно предварительное лечение аналогами соматостатина с последующим проведением нейрохирургического вмешательства. В исключительных случаях, как и при других аденомах, возможна лучевая терапия.

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