Reversible Pituitary Enlargement in the Syndrome of Resistance to Thyroid Hormone

We report pituitary enlargement after radioiodine ablation in a patient with elevated thyroid hormones and features of hyperthyroidism. Serum thyrotropin (TSH) levels were elevated despite normal circulating thyroid hormones, suggesting inappropriate TSH secretion associated either with a TSH secret...

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Veröffentlicht in:	Thyroid (New York, N.Y.) N.Y.), 1998-08, Vol.8 (8), p.679-682
Hauptverfasser:	Gurnell, M, Rajanayagam, O, Barbar, I, Jones, M K, Chatterjee, V K
Format:	Artikel
Sprache:	eng
Schlagworte:	Female Humans Hyperthyroidism - radiotherapy Hypertrophy - diagnosis Hypertrophy - etiology Hypertrophy - physiopathology Iodine Radioisotopes - therapeutic use Magnetic Resonance Imaging Middle Aged Pituitary Gland - pathology Pituitary Gland - physiopathology Point Mutation Receptors, Thyroid Hormone - genetics Thyroid Gland - radiation effects Thyroid Hormone Resistance Syndrome - complications Thyroid Hormone Resistance Syndrome - drug therapy Thyroid Hormone Resistance Syndrome - genetics Thyrotropin - blood Thyrotropin-Releasing Hormone - blood Thyroxine - therapeutic use Tomography, X-Ray Computed
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creator	Gurnell, M Rajanayagam, O Barbar, I Jones, M K Chatterjee, V K
description	We report pituitary enlargement after radioiodine ablation in a patient with elevated thyroid hormones and features of hyperthyroidism. Serum thyrotropin (TSH) levels were elevated despite normal circulating thyroid hormones, suggesting inappropriate TSH secretion associated either with a TSH secreting pituitary adenoma or resistance to thyroid hormone (RTH). Normal serum glycoprotein α-subunit levels and a preserved TSH response to thyrotropin-releasing hormone (TRH) favored RTH and this diagnosis was confirmed by showing the patient to be heterozygous for a missense mutation (R438H) in the thyroid hormone β receptor (TRβ) gene. Thyroxine replacement in supraphysiological doses were required to normalize TSH levels and resulted in regression of the pituitary enlargement, suggesting hyperplasia rather than coincident tumor. This case illustrates the need to avoid thyroid ablation in RTH patients and the importance of supraphysiological thyroxine replacement to prevent pituitary hyperplasia.
doi_str_mv	10.1089/thy.1998.8.679
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Serum thyrotropin (TSH) levels were elevated despite normal circulating thyroid hormones, suggesting inappropriate TSH secretion associated either with a TSH secreting pituitary adenoma or resistance to thyroid hormone (RTH). Normal serum glycoprotein α-subunit levels and a preserved TSH response to thyrotropin-releasing hormone (TRH) favored RTH and this diagnosis was confirmed by showing the patient to be heterozygous for a missense mutation (R438H) in the thyroid hormone β receptor (TRβ) gene. Thyroxine replacement in supraphysiological doses were required to normalize TSH levels and resulted in regression of the pituitary enlargement, suggesting hyperplasia rather than coincident tumor. 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Serum thyrotropin (TSH) levels were elevated despite normal circulating thyroid hormones, suggesting inappropriate TSH secretion associated either with a TSH secreting pituitary adenoma or resistance to thyroid hormone (RTH). Normal serum glycoprotein α-subunit levels and a preserved TSH response to thyrotropin-releasing hormone (TRH) favored RTH and this diagnosis was confirmed by showing the patient to be heterozygous for a missense mutation (R438H) in the thyroid hormone β receptor (TRβ) gene. Thyroxine replacement in supraphysiological doses were required to normalize TSH levels and resulted in regression of the pituitary enlargement, suggesting hyperplasia rather than coincident tumor. This case illustrates the need to avoid thyroid ablation in RTH patients and the importance of supraphysiological thyroxine replacement to prevent pituitary hyperplasia.</abstract><cop>United States</cop><pmid>9737363</pmid><doi>10.1089/thy.1998.8.679</doi><tpages>4</tpages></addata></record>
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subjects	Female Humans Hyperthyroidism - radiotherapy Hypertrophy - diagnosis Hypertrophy - etiology Hypertrophy - physiopathology Iodine Radioisotopes - therapeutic use Magnetic Resonance Imaging Middle Aged Pituitary Gland - pathology Pituitary Gland - physiopathology Point Mutation Receptors, Thyroid Hormone - genetics Thyroid Gland - radiation effects Thyroid Hormone Resistance Syndrome - complications Thyroid Hormone Resistance Syndrome - drug therapy Thyroid Hormone Resistance Syndrome - genetics Thyrotropin - blood Thyrotropin-Releasing Hormone - blood Thyroxine - therapeutic use Tomography, X-Ray Computed
title	Reversible Pituitary Enlargement in the Syndrome of Resistance to Thyroid Hormone
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