Conclusion and Results (Outcome and follow-up):
After four weeks, the patient achieved a euthyroid state and
subsequently underwent endoscopic trans-sphenoidal surgery.
Postoperatively, serum TSH, FT4, and FT3 levels decreased to within the
normal range.
This case illustrates that the elevated TSH was due to the rare
condition of TSHoma, which required timely surgical intervention.
However, due to a misdiagnosis and prior treatment with thyroxine
replacement, the patient’s symptoms were initially aggravated, delaying
appropriate management.