title: Multiple Hürthle cell adenomas in a patient with thyroid hormone resistance.
abstract: BACKGROUND
  Thyroid hormone resistance (RTH) is a rare cause of thyroid dysfunction. High TSH levels, as described in RTH syndrome, are known to be associated with an increased risk of developing thyroid nodules with subsequent growth and malignancy.
  
  
  METHODS
  In 2006, a 29-year-old Caucasian man presented with a palpable mass in the neck. Increased free thyroxine and triiodothyronine levels were found in the context of unsuppressed TSH levels, despite no signs or symptoms of hyperthyroidism. Ultrasonography revealed a multinodular and enlarged goitre, and fine-needle aspiration cytology revealed suspicious features of malignancy. After excluding pituitary tumour and levothyroxine (l-T4) treatment, the patient was diagnosed with generalized RTH. Screening for all the known mutations in thyroid hormone receptor-β (TR β (THRB)) was negative. Thyroidectomy disclosed five Hürthle adenomas and three hyperplasic nodules. Euthyroidism was achieved after surgery with 6.1 μg/kg per day of l-T4.
  
  
  CONCLUSIONS
  RTH may be a risk factor that predisposes to the development of multiple Hürthle cell adenomas. To our knowledge, this is the first case of multiple Hürthle cell adenomas in a patient with RTH.
  
  
  CONCLUSIONS
  High TSH levels, as described in RTH syndrome, are known to be associated with an increased risk of developing thyroid nodules, with subsequent growth and malignancy.The exact role of TR β mutants in thyroid carcinogenesis is still undefined.We report the first case of multiple Hürthle cell adenomas associated with RTH.
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition Hospital Dr Josep Trueta Girona Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Xifra
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition Hospital Dr Josep Trueta Girona Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mauri
authors.affiliation: Department of Surgery Hospital Dr Josep Trueta Girona Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gironès
authors.affiliation: Department of Surgery Hospital Dr Josep Trueta Girona Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Rodríguez Hermosa
authors.affiliation: Biochemistry and Molecular Genetics Department CDB Hospital Clinic Barcelona Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Oriola
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition Hospital Dr Josep Trueta Girona Spain.
authors.forename: Wifredo
authors.initials: W
authors.lastname: Ricart
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition Hospital Dr Josep Trueta Girona Spain ; CIBERobn, patophysiology of obesity and nutrition Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Fernández-Real