Thyroid-stimulating hormone (TSH) secreting pituitary adenoma is a rare but important cause of thyrotoxicosis. It poses a challenge for both diagnosis and management. We report the case of a young Chinese man presenting with thyrotoxicosis, complicated by congestive heart failure, secondary to a TSH secreting pituitary adenoma. The case illustrates the importance of prompt diagnosis and allows discussion of both medical and surgical management, including the use of a long-acting somatostatin analogue.