>Cirugía y Cirujanos
>Year 2011, Issue 5
Guerra-Argüero LM, Gutiérrez-Saucedo JA, Gómez-Coello A, Gállego-Suárez C, Vázques Mellado-Septién A
Resistance to thyroid hormone and Hashimoto’s thyroiditis
Cir Cir 2011; 79 (5)
PDF: 375.35 Kb.
[Full text - PDF]
Background: Resistance to thyroid hormone (RTH) is a rare condition characterized by elevation of thyroid stimulating hormone (TSH) and thyroid hormones (TH). Its association with Hashimoto’s thyroiditis was described in 1993 and occurs in 1/1.3 million births.
Clinical case: We present a female patient with a family history of hypothyroidism. The patient’s condition began in 2008 with symptoms of hyperthyroidism, elevated triiodothyronine (T3), thyroxine (T4) and TSH levels. Thyroid scan showed hypermetabolic activity and she was positive for anti-peroxidase antibodies (anti-TPO). After administration of thiamazole, TSH increased. In 2009 she was diagnosed with clinical hypothyroidism, high levels of TSH, and normal T3 and T4 levels. Levothyroxine was prescribed but TSH increased and she presented clinical signs of hyperthyroidism. Patient abandoned treatment after 1 month. Her symptoms fluctuated among hyperthyroidism, euthyroidism and hypothyroidism. In 2010 she presented tachycardia, weight loss, and high T3, T4 and TSH levels. Thyrotropin-secreting adenoma (TSHoma) was suspected and ruled out by magnetic resonance imaging (MRI). Thyrotropin releasing hormone (TRH) test was performed. TSH increased and the α- subunit of pituitary hormones retained low levels.
Conclusions: RTH diagnosis requires exclusion of a TSHoma because both present a similar pattern according to thyroid tests. The association between Hashimoto’s thyroiditis and RTH is not well known. This pathological condition has a mutated TRβ gene in 75% of the cases.
||Resistance to thyroid hormone, thyroid hormones, thyrotropin-secreting adenoma, triiodothyronine, thyroxine.
Mamanasiri S, Yesil S, Dumitrescu A, Liao X, Demir T, Weiss R, et al. Mosaicism of a thyroid hormone receptor-β gene mutation in resistance to thyroid hormone. J Clin Endocrinol Metab 2006;91:3471-3477.
Lafranchi S, Synder D, Sesser D, Skeels M, Singh N, Brent G, et al. Follow-up of newborns with elevated screening T4 concentrations. J Pediatr 2003;143:296- 301.
Weiss R, Refetoff S. Resistance to thyroid hormone (RTH) in the absence of abnormal thyroid hormone receptor (TR) (nonTR-RTH). Hot Thyroidol 2009;9:1-10.
Kronenberg HM, Melmed SM, Polonsky KS, Larsen PR. Williams Tratado de Endocrinología. Décima prima edición. Madrid: Elsevier Saunders; 2009. pp. 299-320.
Rojkind A, Pettuzi D, Viale F, Rivolta C, Olcese C, Targounik H, et al. Resistencia a hormonas tiroideas (RHT). Descripción de una nueva mutación. RAEM 2009;46:17-24.
Khandwala H, Lee Ch. Inappropriate secretion of thyroid-stimulating hormone. CMAJ 2006;175:351-353.
Beck-Peccoz P, Persani L, Mannavola D, Campi I. TSH-secreting adenomas. Best Prac Res Clin Endocrinol Metab 2009;23:597-606.
Bahceci M, Tuzcu A, Tuzcu S. A case of thyrotropin-secreting pituitary adenoma (TSHoma). Turk Jem 2002;4:159-162.
Poyrazoglu S, Tütüncüler F, Bas F, Darendeliler F. Resistance to thyroid hormone in a Turkish child with A317T mutation in the thyroid hormone receptor-beta gene. Turk J Pediatr 2008;50:577-580.
Ando S, Sarlis NJ, Krishnan J, Feng X, Refetoff S, Zhang M, et al. Aberrant alternative splicing of thyroid hormone receptor in a THSsecreting pituitary tumor is a mechanism for hormone resistance. Mol Endocrinol 2001;15:1529-1538.
Ando S, Sarlis NJ, Oldfield EH, Yen PM. Somatic mutation of TRbeta can cause a defect in negative regulation of THS in a TSH-secreting pituitary tumor. J Clin Endocrinol Metab 2001;86:5572-5576.
Brucker Davies F, Oldfield E, Skarulis M, Doppman J, Weintraub B. Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 1999;84:476:486.
Tonacchera M, Agretti P, De Marco P, Perri A, Pinchera A, Vitti P, et al. Thyroid resistance to TSH complicated by autoimmune thyroiditis. J Clin Endocrinol Metab 2001;86:4543-4546.
Gavin C, Meggison H, Chye T. Proposing a causal link between thyroid hormone resistance and primary autoimmune hypothyroidism. Med Hypotheses 2008;70:1024-1028.
Tjorve E, Tjorve KMC, Olsen JC, Senum R, Oftebro H. On commonness and rarity of thyroid hormone resistance: a discussion based on mechanisms of reduced sensitivity in peripheral tissues. Med Hypotheses 2007;69:913-921.
Lavin N. Manual of Endocrinology and Metabolism. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 431.
>Cirugía y Cirujanos
>Year 2011, Issue 5