[Hyperthyroidism at elevated thyreostimulin. A case with pituitary resistance to thyroid hormones].
Simultaneous elevation of thyreostimulin and thyroid hormones values, when associated with clinical hyperthyroidism, raises a dual problem of diagnosis and treatment. We report a case of hyperthyroidism with elevated thyreostimulin in a young adult man. The values of free triiodothyronin and free thyroxin were elevated and the thyroxin binding globulin was normal. A normal pituitary tomodensitometry, the normal values of the alpha sub-unit of thyreostimulin and the dynamic tests of thyreostimulin secretion allowed us to rule out the hypothesis of a pituitary adenoma. Non-tumoral inappropriate secretions of thyreostimulin are at present regarded as syndromes of resistance to thyroid hormones. Their biological translation is a simultaneous elevation of thyreostimulin and thyroid hormones. Peripheral resistance, which is rarely complete, finds its expression in clinical hyperthyroidism or in normal clinical condition, whereas pituitary resistance, which causes the lack of feedback on the secretion of thyreostimulin expresses itself by clinical hyperthyroidism, sometimes with goitre owing to the trophic action of thyreostimulin on the thyroid. Generalized syndromes of resistance are the most common. Our patient had a selective pituitary resistance to thyroid hormones and less than thirty cases are reported in the literature. Treatment with a beta-blocker remains indicated when facing clinical evidence for hyperthyroidism and oral triiodothyronin seems to be able to slow down the inappropriate secretion of thyreostimulin. Regarding our patient who experienced a clinical and biological relapse after the stopping of the treatment, we join many authors who recommend a prolonged treatment.
Service de Médecine interne, Pavillon Giraud, Centre hospitalier Lyon-Sud, Pierre-Bénite.
X
X
Brechignac
C
C
Broussolle
R
R
Nove-Josserand
D
D
Vital-Durand
J
J
Orgiazzi
R
R
Levrat
D000328:Adult; D004359:Drug Therapy, Combination; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D010900:Pituitary Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D011433:Propranolol / Q000627:therapeutic use; D012008:Recurrence; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood*; D013975:Thyroxine-Binding Proteins / Q000032:analysis; D014284:Triiodothyronine / Q000097:blood* / Q000627:therapeutic use
D013975:Thyroxine-Binding Proteins; D014284:Triiodothyronine; D013972:Thyrotropin; D011433:Propranolol; D013974:Thyroxine
Hyperthyroïdie à thyréostimuline haute. Une observation avec résistance hypophysaire aux hormones thyroïdiennes.