The syndrome of resistance to thyroid hormone, misdiagnosed and treated as thyrotoxicosis.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
I A MohammedN Iqbal

Abstract

To report two cases of resistance to thyroid hormone and to promote increased awareness of this syndrome, which is frequently misdiagnosed and incorrectly treated. We describe a young woman and her father, both of whom were diagnosed at a younger age as having thyrotoxicosis and were treated with thyroidectomy and radioactive iodine. Both patients later proved to have resistance to thyroid hormone and required supraphysiologic doses of levothyroxine to normalize the thyroid-stimulating hormone (TSH) while remaining euthyroid. Laboratory evaluation revealed increased serum total thyroxine and triiodothyronine levels as well as normal to increased TSH levels. The free alpha sub-unit/TSH ratio was normal, and magnetic resonance imaging of the pituitary gland showed no tumor. Metabolic studies in the daughter, with use of graded doses of triiodothyronine, supported the diagnosis. Both patients shown to have resistance to thyroid hormone were misdiagnosed and inappropriately treated in the past. The resultant hypothyroidism has been difficult to treat, particularly in the father who has coronary artery disease.

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Citations

May 21, 2011·Thyroid : Official Journal of the American Thyroid Association·Amin Sabet, Johanna A Pallotta
Apr 12, 2014·Hormones : International Journal of Endocrinology and Metabolism·Antonio J AmorJosep Oriola
Jun 15, 2006·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Huy A Tran

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