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A 32-year-old woman was referred from the gynecology clinic with a history of oligomenorrhea of 9 years' duration and amenorrhea for the previous 6 months. Her chief concerns were lethargy, systemic swelling, muscle aches, dryness of skin, and hair loss. Galactorrhea on expression had been noted by the referring physician. Before occurrence of these symptoms, her menstrual cycles had been regular. Long-standing untreated primary hypothyroidism can lead to thyrotroph cell hyperplasia due to prolonged thyrotropin-releasing hormone stimulation. This may manifest as an enlarged pituitary gland with a mass lesion that may mimic a macroadenoma. A high index of suspicion for untreated hypothyroidism is needed, and routine testing of the thyroid hormone profile is imperative in patients with pituitary tumors and galactorrhea. These mass lesions respond well to thyroxine replacement, which can help avoid unnecessary treatment with a dopamine agonist, radiotherapy, or surgical intervention.