{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T08:08:15Z","timestamp":1753862895910,"version":"3.41.2"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>Hypophyseal dysfunction may be overlooked by the currently generally accepted laboratory routine for the differential diagnosis in patients suffering from symptoms of depression or dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Hypothyroidism is an important cause of depression and potentially reversible cognitive impairment. Whereas the determination of the plasma concentration of thyrotropin (TSH) is generally considered part of the laboratory screening tests for dementia, the measurement of total or free triiodothyronine (T3, FT3), thyroxine (T4, FT4) and cortisol in plasma does not belong to the routine diagnostic workup in patients with depression or suspected dementia. In an 87\u2010year\u2010old lady suffering from increasingly poor general health, decreased fluid and food intake, mood depression and lack of energy, three measurements of plasma TSH produced normal values. A cranial computed tomography (cCT) 2\u2009days prior to hospital admission had been assessed as apparently normal. A second cCT performed following a loss of consciousness complicated by tongue bite showed a hypophyseal tumor. Then, low plasma levels of FT3, FT4 and cortisol were found. Following hormone replacement and transsphenoidal tumor resection, the patient recovered rapidly. The present case report illustrates the pitfalls of measuring merely the TSH level in the detection of thyroid and hypophyseal dysfunction.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.8813","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T06:39:06Z","timestamp":1715150346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A fortunate bitten tongue\u2014Hypothyroidism despite repeatedly normal plasma thyrotropin levels"],"prefix":"10.1002","volume":"12","author":[{"given":"Marija","family":"Djukic","sequence":"first","affiliation":[{"name":"Department of Neuropathology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"Department of Geriatrics Evangelisches Krankenhaus G\u00f6ttingen\u2010Weende  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Gossner","sequence":"additional","affiliation":[{"name":"Department of Radiology Evangelisches Krankenhaus G\u00f6ttingen\u2010Weende  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1603-9319","authenticated-orcid":false,"given":"J\u00f6rg","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Radiology University Medical Center  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatima Barbara","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Neuropathology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans\u2010Ulrich","family":"Schildhaus","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Pathologie Nordhessen  Kassel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veit","family":"Rohde","sequence":"additional","affiliation":[{"name":"Department of Neurosugery University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-995X","authenticated-orcid":false,"given":"Roland","family":"Nau","sequence":"additional","affiliation":[{"name":"Department of Neuropathology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"Department of Geriatrics Evangelisches Krankenhaus G\u00f6ttingen\u2010Weende  G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33987"},{"key":"e_1_2_13_3_1","unstructured":"World Health Organization.ICD\u201010 Version: 2019. https:\/\/icd.who.int\/browse10\/2019\/en#\/F00\u2010F092024."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14424"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-015-0583-3"},{"volume-title":"Dementia: A NICE\u2010SCIE Guideline on Supporting People with Dementia and their Carers in Health and Social Care","year":"2007","author":"National Collaborating Centre for Mental Health (commissioned by the Social Care Institute for Excellence and the National Institute for Health and Clinical Excellence)","key":"e_1_2_13_6_1"},{"key":"e_1_2_13_7_1","unstructured":"DGN e. 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