title: Genetics and phenomics of hypothyroidism due to TSH resistance.
abstract: The resistance to thyrotropin (TSH) action is the disease associated with molecular defects hampering the adequate transmission of TSH stimulatory signal into thyroid cells. The defect may in principle affect every step along the cascade of events following the binding of TSH to its receptor (TSHR) on thyroid cell membranes. After the description of the first family affected with loss-of-function (LOF) TSHR mutations in 1995, there is now evidence that TSH resistance is a disease with a broad range of expressivity going from severe congenital hypothyroidism (CH) with thyroid hypoplasia to mild hyperthyrotropinemia (hyperTSH) associated with an apparent euthyroid state. More severe forms occur in patients with disrupting biallelic TSHR mutations and follow a recessive pattern of inheritance. Differential diagnosis in these cases includes the exclusion of other causes of thyroid dysgenesis, such as mutations in thyroid transcription factors. More mild forms may instead occur in patients with monoallelic TSHR defects following a dominant mode of inheritance. In these cases we described the dominant negative effect exerted by some LOF mutants on the activity of the wild-type TSHR. Differential diagnosis involves the exclusion of mild hypothyroidism in autoimmune thyroid disease or pseudohypoparathyroidism associated with genetic or epigenetic defects at the GNAS locus. This review will focus on the prevalence of TSHR mutations, on the molecular mechanisms leading to TSH resistance and on the variable clinical expression of this disease.
authors.affiliation: Dipartimento di Scienze Mediche, Università degli Studi di Milano, Italy. luca.persani@unimi.it
authors.forename: Luca
authors.initials: L
authors.lastname: Persani
authors.forename: Davide
authors.initials: D
authors.lastname: Calebiro
authors.forename: Daniela
authors.initials: D
authors.lastname: Cordella
authors.forename: Giovanna
authors.initials: G
authors.lastname: Weber
authors.forename: Giulia
authors.initials: G
authors.lastname: Gelmini
authors.forename: Domenico
authors.initials: D
authors.lastname: Libri
authors.forename: Tiziana
authors.initials: T
authors.lastname: de Filippis
authors.forename: Marco
authors.initials: M
authors.lastname: Bonomi
mesh_terms: D005838:Genotype; D006801:Humans; D007037:Hypothyroidism / Q000235:genetics* / Q000378:metabolism / Q000503:physiopathology; D010641:Phenotype; D011989:Receptors, Thyrotropin / Q000235:genetics* / Q000378:metabolism; D013972:Thyrotropin / Q000235:genetics* / Q000378:metabolism
chemical_list: D011989:Receptors, Thyrotropin; D013972:Thyrotropin