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Rapid Progression of Pituitary Hyperplasia in Humans with Primary Hypothyroidism: Demonstration with MR Imaging¹

¹ From the Department of Nuclear Medicine and Radiology, Faculty of Medicine, Kyoto University, 54 Shogoinkawahara-cho Sakyo-ku Kyoto, 606-8507, Japan (T.S., H.H., K.K., Y.M., S.N., T.M., A.H., J.K.), and the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (H.H.). Received November 20, 1998; revision requested January 18, 1999; revision received February 22; accepted April 15. Address reprint requests to T.S. (e-mail: shimono@kuhp .kyto-u.ac.jp).

PURPOSE: To use magnetic resonance (MR) imaging to evaluate the morphologic changes of the pituitary gland during the development of hypothyroidism.

MATERIALS AND METHODS: Fourteen patients who had undergone thyroidectomy were evaluated before radioactive iodine 131 therapy. In each patient, MR imaging and measurement of serum hormone levels were performed twice: 5 weeks before ¹³¹I treatment as the "euthyroid state" with thyroid hormone supplementation and on the day of ¹³¹I treatment as the "hypothyroid state" after a 3-week depletion of thyroid hormone supplements. Nine healthy volunteers also underwent MR imaging twice at an interval of 5 weeks. Pituitary volume and the relative signal intensity ratio of the anterior pituitary to the pons were measured. The shape and signal intensity of the pituitary gland were also visually assessed. The paired Student t test was used to evaluate the significance of the data. A P value less than .05 indicated a statistically significant difference.

RESULTS: The patients had significantly larger pituitary volume in the hypothyroid state than in the euthyroid state both quantitatively (P < .001) and visually. No significant differences were found in the relative signal intensity ratios of the anterior pituitary to the pons. In healthy volunteers, no significant differences in pituitary volumes or signal intensity were found between the two MR images.

CONCLUSION: Rapid progression of hyperplasia of the anterior pituitary may occur with acute development of hypothyroidism.

Index terms: Pituitary, abnormalities, 145.144, 145.458, 145.521 • Thyroid, hypothyroidism, 273.458, 273.521 • Pituitary, MR, 145.12141

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