Figure 1. Clinical manifestations in patients with TSH-secreting adenomas. Patients have been divided into two categories according to previous thyroid surgery. The presence of goiter is the rule, even in patients with partial thyroidectomy. Hyperthyroid features may be overshadowed by those of associated hypersecretion/deficiency of other pituitary hormones. Invasive tumors are seen in about half of the patients with previous thyroidectomy and in 1/4 of untreated patients (P<0.01 by Fisher's exact test). Intrasellar tumors show an opposite distribution pattern.