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Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case

  • Authors:
    • Bayar A. Qasim
    • Sardar H. Arif
    • Ashur Y. Izac
    • Halder J. Abozait
    • Rende S.A. Kochary

  • View Affiliations / Copyright

    Affiliations: Department of Medicine, College of Medicine, University of Duhok, Duhok 42001, Kurdistan Region, Iraq, Department of Surgery, College of Medicine, University of Duhok, Duhok 42001, Kurdistan Region, Iraq
    Copyright: © Qasim et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 2
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    Published online on: November 18, 2025
       https://doi.org/10.3892/mi.2025.286
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Abstract

Acromegaly is most commonly caused by a growth hormone (GH)‑secreting pituitary adenoma; the spontaneous regression of such tumors is exceedingly rare. The present study reports the case of a 51‑year‑old male patient with long‑standing acromegaly who developed a toxic multinodular goiter complicated by superior vena cava obstruction (SVCO). An initial evaluation revealed a pituitary macroadenoma measuring 19x17x16 mm, with elevated GH and insulin‑like growth factor‑1 (IGF‑1) levels, consistent with acromegaly. The patient was treated with a somatostatin analog and metformin for glycemic control, followed by carbimazole in preparation for thyroidectomy. He subsequently underwent urgent total thyroidectomy for compressive symptoms due to SVCO. Post‑thyroidectomy, he experienced marked clinical improvement, including the resolution of dyspnea, improved sleep quality, enhanced mood and partial regression of acromegaly symptoms. Biochemically, IGF‑1 normalized within 6 months of total thyroidectomy, and an MRI demonstrated the progressive shrinkage of the pituitary adenoma, reducing to 8x6x5.5 mm at 1 year without neurosurgical intervention. Possible mechanisms for regression include perioperative pituitary apoplexy, spontaneous ischemia, or altered vascular dynamics following thyroidectomy. The present case report highlights the importance of reassessing pituitary adenomas following the treatment of coexisting endocrine or compressive disorders and suggests a potential role of vascular factors in pituitary tumor regression.
View Figures

Figure 1

MRI of the pituitary gland in a 51-year-old male patient with acromegaly. (A) Prior to thyroidectomy, there was a pituitary macroadenoma (yellow arrow, 19x17x16 mm). (B) MRI illustrating the regression of the tumor to a microadenoma (yellow arrow, 8x6x5.5 mm) at 12 months following thyroidectomy. The red star indicates the pons.

Figure 2

(A) Distended neck veins in a 51-year-old male patient with retrosternal goiter and superior vena cava obstruction. (B) Intraoperative image of a 260-g thyroid gland; the right lobe measured 110x70x50 mm with a 65-mm spherical nodule while left lobe measured 60x40 mm.

Figure 3

(A) Chest radiograph illustrating a retrosternal mass (yellow arrows). (B) Computed tomography scan of the chest illustrating a heterogenous thyroid mass the is extending retrosternally (yellow arrow), compressing superior vena cava (red arrowhead) and pushing trachea to the left side.

Figure 4

Fine-needle aspiration cytology smears from a 51-year-old male with retrosternal goiter illustrating (A and B) groups of follicular epithelial cell in a colloid-rich background [H&E staining; magnification: (A) x5, (B) x20] with (C) scattered hemosiderin-laden macrophages (H&E staining; magnification x20). Cytomorphological features are consistent with a benign thyroid lesion (Thy 2).
View References

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Copy and paste a formatted citation
Spandidos Publications style
Qasim BA, Arif SH, Izac AY, Abozait HJ and Kochary RS: Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case. Med Int 6: 2, 2026.
APA
Qasim, B.A., Arif, S.H., Izac, A.Y., Abozait, H.J., & Kochary, R.S. (2026). Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case. Medicine International, 6, 2. https://doi.org/10.3892/mi.2025.286
MLA
Qasim, B. A., Arif, S. H., Izac, A. Y., Abozait, H. J., Kochary, R. S."Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case". Medicine International 6.1 (2026): 2.
Chicago
Qasim, B. A., Arif, S. H., Izac, A. Y., Abozait, H. J., Kochary, R. S."Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case". Medicine International 6, no. 1 (2026): 2. https://doi.org/10.3892/mi.2025.286
Copy and paste a formatted citation
x
Spandidos Publications style
Qasim BA, Arif SH, Izac AY, Abozait HJ and Kochary RS: Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case. Med Int 6: 2, 2026.
APA
Qasim, B.A., Arif, S.H., Izac, A.Y., Abozait, H.J., & Kochary, R.S. (2026). Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case. Medicine International, 6, 2. https://doi.org/10.3892/mi.2025.286
MLA
Qasim, B. A., Arif, S. H., Izac, A. Y., Abozait, H. J., Kochary, R. S."Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case". Medicine International 6.1 (2026): 2.
Chicago
Qasim, B. A., Arif, S. H., Izac, A. Y., Abozait, H. J., Kochary, R. S."Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case". Medicine International 6, no. 1 (2026): 2. https://doi.org/10.3892/mi.2025.286
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