title: Management of differentiated thyroid cancer in the presence of resistance to thyroid hormone and TSH-secreting adenomas: a report of four cases and review of the literature.
abstract: BACKGROUND
  An increased or normal serum TSH concentration, despite elevated thyroid hormone levels, is observed in resistance to thyroid hormone (RTH) and TSH-secreting adenomas (TSHomas). When coexistent with a differentiated thyroid cancer (DTC), maintenance of a suppression of TSH is challenging.
  
  
  OBJECTIVE
  The aim of the study was to discuss the pitfalls arising from the failure to suppress TSH secretion in DTC and the strategies for proper treatment of DTC in association with RTH and TSHoma.
  
  
  METHODS
  Four unusual cases of DTC associated with TSHoma (2 cases), RTH (1 case), and an elevated TSH of unknown etiology (1 case) are presented, and the literature is reviewed.
  
  
  RESULTS
  Although a persistent mild TSH elevation may not be a risk factor for the development of DTC, it represents an important problem during the treatment of DTC. Aggressive treatment options should be applied in the proper order to prevent tumor recurrence and persistence in the absence of ideal TSH suppression.
  
  
  CONCLUSIONS
  Although there is no agreed consensus regarding the management of DTC in the presence of persistent hyperthyrotropinemia, complete tumor removal followed by radioablation and attempts to reduce the serum TSH to the lowest tolerable level are recommended. The outcomes in the reported cases have not been unfavorable, despite the persistence of nonsuppressed TSH.
authors.affiliation: Ankara University School of Medicine, Department of Endocrinology and Metabolism, 06100 Ankara, Turkey. ugurunluturk@gmail.com
authors.forename: Uğur
authors.initials: U
authors.lastname: Ünlütürk
authors.forename: Chutintorn
authors.initials: C
authors.lastname: Sriphrapradang
authors.forename: Murat Faik
authors.initials: MF
authors.lastname: Erdoğan
authors.forename: Rifat
authors.initials: R
authors.lastname: Emral
authors.forename: Sibel
authors.initials: S
authors.lastname: Güldiken
authors.forename: Samuel
authors.initials: S
authors.lastname: Refetoff
authors.forename: Sevim
authors.initials: S
authors.lastname: Güllü
mesh_terms: D000236:Adenoma / Q000378:metabolism*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000378:metabolism*; D018382:Thyroid Hormone Resistance Syndrome / Q000150:complications*; D013964:Thyroid Neoplasms / Q000097:blood / Q000628:therapy*; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism*
chemical_list: D013972:Thyrotropin
references.citation: Clin Endocrinol (Oxf). 2001 Jan;54(1):121-4
references.pmid: 11167935
references.citation: Am J Med Sci. 2009 Jun;337(6):462-5
references.pmid: 19390430
references.citation: Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):1009-21
references.pmid: 19041828
references.citation: J Clin Endocrinol Metab. 2001 Apr;86(4):1447-63
references.pmid: 11297567
references.citation: Thyroid. 1998 Feb;8(2):181-3
references.pmid: 9510128
references.citation: Endocrinol Metab Clin North Am. 2007 Sep;36(3):753-78, vii
references.pmid: 17673127
references.citation: J Endocrinol Invest. 1983 Jun;6(3):217-23
references.pmid: 6619530
references.citation: Endocr J. 2000 Dec;47(6):731-8
references.pmid: 11228048
references.citation: J Neurosurg. 2000 Aug;93(2):194-200
references.pmid: 10930003
references.citation: Exp Clin Endocrinol Diabetes. 2006 Jul;114(7):389-92
references.pmid: 16915543
references.citation: Thyroid. 2010 Jan;20(1):99-103
references.pmid: 20067380
references.citation: J Clin Endocrinol Metab. 1999 Nov;84(11):3877-85
references.pmid: 10566623
references.citation: J Endocrinol Invest. 1991 Jun;14(6):499-502
references.pmid: 1774446
references.citation: Postgrad Med J. 2008 Sep;84(995):473-7
references.pmid: 18940949
references.citation: J Clin Endocrinol Metab. 1976 Feb;42(2):395-8
references.pmid: 177443
references.citation: Pituitary. 2001 Sep;4(4):271-4
references.pmid: 12501979
references.citation: Pituitary. 2002;5(2):83-8
references.pmid: 12675505
references.citation: Thyroid. 2011 Jul;21(7):793-7
references.pmid: 21649470
references.citation: Thyroid. 2002 Nov;12(11):963-9
references.pmid: 12490073
references.citation: J Clin Endocrinol Metab. 1996 Dec;81(12):4318-23
references.pmid: 8954034
references.citation: Endocrinol Metab Clin North Am. 2008 Mar;37(1):123-34, viii-ix
references.pmid: 18226733
references.citation: J Clin Endocrinol Metab. 2007 Jul;92(7):2610-5
references.pmid: 17426094
references.citation: Am J Med. 1994 Nov;97(5):418-28
references.pmid: 7977430
references.citation: Nat Clin Pract Endocrinol Metab. 2005 Nov;1(1):32-40
references.pmid: 16929364
references.citation: JAMA. 1966 Feb 28;195(9):721-4
references.pmid: 5951875
references.citation: Recent Results Cancer Res. 1990;118:48-63
references.pmid: 2173080
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):2682-92
references.pmid: 22622023
references.citation: Endocr Pract. 2006 May-Jun;12(3):288-93
references.pmid: 16772202
references.citation: Endocrinology. 2011 Oct;152(10):3986-96
references.pmid: 21846801
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: J Clin Endocrinol Metab. 2012 Apr;97(4):1328-36
references.pmid: 22319036
references.citation: Endocr Rev. 1996 Dec;17(6):610-38
references.pmid: 8969971
references.citation: Thyroid. 1997 Oct;7(5):775-8
references.pmid: 9349583
references.citation: J Korean Med Sci. 2010 Sep;25(9):1368-71
references.pmid: 20808683
references.citation: Horm Res. 1987;26(1-4):79-99
references.pmid: 3297965
references.citation: Thyroid. 2006 Dec;16(12):1229-42
references.pmid: 17199433
references.citation: Biochim Biophys Acta. 2013 Jul;1830(7):3987-4003
references.pmid: 22986150
references.citation: J Clin Endocrinol Metab. 1999 Feb;84(2):476-86
references.pmid: 10022404
references.citation: Thyroid. 1998 Sep;8(9):737-44
references.pmid: 9777742
references.citation: J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):93-5
references.pmid: 17172570
references.citation: J Endocrinol Invest. 2002 Feb;25(2):RC4-6
references.pmid: 11929097