Thyroid hormone resistance without mutations in thyroid hormone receptor beta.
BACKGROUND
Resistance to thyroid hormone (RTH) is a rare autosomal dominant disorder that leads to elevated free thyroid hormone levels in the presence of normal or increased serum thyroid-stimulating hormone (TSH) concentrations if it is generalized because both the pituitary and peripheral tissues are then partially resistant. In approximately 85% of patients with RTH, mutations in the thyroid hormone receptor beta (TR beta) gene can be identified.


METHODS
A 68-year-old German man presented for surgical hernia repair. He was found to have elevated free T3 and T4 plasma concentrations in coexistence with goiter, unsuppressed TSH, arterial hypertension, and arthritis urica/gout. An electrocardiogram showed a normal sinus rhythm with 69 beats per minute. There were neither signs or symptoms of hyper- or hypothyroidism nor psychological abnormalities. Generalized RTH was suspected.


CONCLUSIONS
Generalized RTH should be considered in patients presenting with elevated free thyroid hormone levels and normal or increased TSH concentrations, especially if these patients appear clinically euthyroid. Signs and symptoms of hyper- and hypothyroidism should be evaluated to assure that these patients are candidates for surgical procedures such as hernia repair. Subsequent mutation analysis of the TR beta gene should be conducted to help identify family members. In approximately 15% of patients, mutations in the TR beta gene cannot be identified and raise the possibility of mosaicism.
Bottcher
Yvonne
Y
Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany.
Paufler
Thomas
T
Stehr
Thomas
T
Bertschat
Frank Ludwig
FL
Paschke
Ralf
R
Koch
Christian A
CA
D000368:Aged; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics*; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology; D037042:Thyroid Hormone Receptors beta / Q000235:genetics*; D018382:Thyroid Hormone Resistance Syndrome / Q000235:genetics*
D037042:Thyroid Hormone Receptors beta