Hypothyroidism: This condition can lead to increased TSH levels. High TSH can stimulate the ovaries or testes to produce more sex hormones, including testosterone and estradiol, due to the cross-talk between the hypothalamic-pituitary-thyroid axis and the hypothalamic-pituitary-gonadal axis. Additionally, hypothyroidism can lead to increased levels of sex hormone-binding globulin (SHBG), which can affect the levels of free testosterone and estradiol.

Polycystic Ovary Syndrome (PCOS): Characterized by hyperandrogenism (high testosterone), PCOS can also present with high estradiol levels due to peripheral conversion of androgens to estrogens in adipose tissue. The high TSH could be coincidental or related to the metabolic disturbances often seen in PCOS.
Thyroid Hormone Resistance: A rare condition where the body's tissues are resistant to thyroid hormones, leading to elevated TSH and thyroid hormone levels. This could potentially disrupt the normal feedback mechanisms and lead to increased production of sex hormones.
Adrenal Hyperplasia: Certain forms of congenital adrenal hyperplasia can lead to an overproduction of androgens, which can be converted to estrogens, resulting in high estradiol levels. The high TSH might be unrelated or could be influenced by the metabolic and hormonal imbalances.

Pituitary Tumor (e.g., Prolactinoma or Non-functioning Adenoma): Although less common, a pituitary tumor could disrupt the normal production and regulation of hormones, including TSH, testosterone, and estradiol. Missing this diagnosis could have significant consequences due to the potential for the tumor to grow and cause further hormonal imbalances or compress surrounding structures.
Thyroid Cancer with Metastasis to the Pituitary: A rare scenario where thyroid cancer metastasizes to the pituitary gland, potentially disrupting hormone regulation and leading to abnormal TSH and sex hormone levels.

Aromatase Excess Syndrome: A rare genetic condition leading to an overproduction of aromatase, the enzyme responsible for converting androgens to estrogens. This could result in high estradiol levels and potentially affect testosterone levels and TSH through feedback mechanisms.
Familial Gestational Hyperthyroidism: Although typically associated with pregnancy, some familial forms of gestational hyperthyroidism could potentially present with similar hormonal imbalances outside of pregnancy, including elevated TSH and sex hormones due to genetic predispositions affecting thyroid and gonadal function.