Increased thyrotrophin levels and loss of the nocturnal thyrotrophin surge in Sheehan's syndrome

Clinical Endocrinology
J AbuchamJ G Vieira

Abstract

Since panhypopituitarism in patients with Sheehan's syndrome is due to massive pituitary necrosis with only minor hypothalamic involvement, we hypothesized that serum TSH levels would be low but its circadian rhythm preserved in these patients. Basal and TRH-stimulated mean afternoon (1500-1700 h) and nocturnal (0100-0300 h) TSH levels were determined in 10 patients with Sheehan's syndrome before and during T4/glucocorticoid replacement and in seven controls. Serum concentrations of T3, T4, free T4 (fT4) and cortisol were measured by radio-immunoassay; TSH, GH, PRL and LH were determined by immunofluorimetric assay. Afternoon TSH levels were markedly increased in Sheehan's syndrome patients compared with controls (3.3 +/- 1.0 vs 0.5 +/- 0.15 mU/l, respectively, P = 0.002). At night, TSH levels remained unchanged in Sheehan's syndrome patients (3.3 +/- 1.1 mU/l) but rose significantly in controls (1.1 +/- 0.34 mU/l, P = 0.016). The nocturnal TSH increment was significantly higher in controls than in patients (143 vs approximately 4.9%, respectively, P = 0.0001). In eight patients with normal serum fT4 levels during treatment, basal TSH levels decreased to 0.16 +/- 0.05 mU/l (P < or = 0.008), being barely detectable or undetectab...Continue Reading

Citations

Jul 7, 2007·Thyroid : Official Journal of the American Thyroid Association·Hulusi AtmacaFahrettin Kelestimur
Oct 1, 2013·Thyroid : Official Journal of the American Thyroid Association·Joshua M EstradaOffie P Soldin
Feb 18, 2016·Archives of Endocrinology and Metabolism·Bashir LawayArshad Wani
Dec 23, 2016·Nature Reviews. Disease Primers·Züleyha KaracaFahrettin Kelestimur
Dec 30, 2017·Indian Journal of Endocrinology and Metabolism·Bashir Ahmad Laway, Sajad Sumji
Apr 12, 2013·Endocrine Reviews·Ferdinand Roelfsema, Johannes D Veldhuis
May 17, 2007·The Journal of Clinical Endocrinology and Metabolism·Juliana H A OliveiraJulio Abucham
Aug 24, 2019·BMJ Case Reports·Navneet KaurAdel Mandl
Sep 18, 2008·Arquivos brasileiros de endocrinologia e metabologia·Manoel R A Martins, Julio Abucham
Sep 2, 2015·Endocrine·Halit DiriFahrettin Kelestimur

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