Case report: A patient with an empty sella accompanied by rare thyrotoxicosis

Liang-qing Guo^1*Xiaochun Han^2*Zhaoyang Li²Kangning Han²Wenhui Yang²Bo Wu¹Rufan Cao²Shiyao Chen²Xinyu Zhang²

• ¹Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
• ²Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China

Empty sella (ES) involves pituitary fossa herniation, causing pituitary flattening. While typically linked to central hypothyroidism, its co-occurrence with hyperthyroidism is rarely reported and often missed. We reported a rare case of hyperthyroidism in a patient with ES. After diagnosis, it was found that the patient was diagnosed with ES combined with Graves' disease (GD) and Hashimoto's thyroiditis (HT). Her pituitary gland is flattened and the upper edge is depressed. The height of the pituitary gland is approximately 2.3mm, and the abnormal thyroid function may be the result of the combined action of the three diseases. Through a literature search in PubMed, we found that ES has a certain relationship with the onset of autoimmune thyroid disease, but there are only seven relevant literature studies and a lack of relevant diagnosis and treatment scheme. Patients with hyperthyroidism often miss the diagnosis of ES. When patients with hyperthyroidism do not return their thyroid function to normal with conventional oral doses of drugs, we should consider the possibility of having ES. When ES is associated with primary hyperthyroidism, the dose of antithyroid drugs should be smaller than the conventional dose, and thyroid function needs to be tested at a higher frequency and the dose of drugs should be adjusted in time.