A Case of The Syndrome of Inappropriate Secretion of TSH

Satô, Tamotsu; K, Saida; Suzuki, Yukichi; Takata, Ikuro; Ishiguro, Kaname

doi:10.1507/endocrj1954.26.623

Cited by 13 publications

(5 citation statements)

References 6 publications

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“…In our patient, PRL increased only minimally with TRH or metoclopramide. This has been observed previously in tumour cases (Baylis, 1976;Horn et aL., 1976;Werner, 1979), although in situations without a tumour, exaggerated responses to TRH have been described (Rosler et aL., 1982;Gershengorn and Weintraub, 1975;Sato et al, 1979).…”

Section: Discussionsupporting

confidence: 78%

“…In contrast, after 3 weeks of T3 treatment in our patient, no change in these parameters occurred except for the partial suppression of the TSH response to TRH. In the majority of the cases of pituitary resistance to thyroid hormones, as well as in the kindred described above, TRH and antithyroid agents stimulate and T3 suppresses TSH Elewaut et al, 1976;Rosler et al, 1982;Gershengorn and Weintraub, 1975;Novogroder et al, 1977;Sato et al, 1979). In one patient (Emerson and Utiger, 1972;Mihailovic et al, 1980) without demonstrable tumour, there was only slight suppression of TSH by thyroid hormone and no stimulation with TRH.…”

Section: Discussionmentioning

confidence: 87%

“…The variable clinical presentation may be related to the fact that the pathophysiological mechanisms causing the syndrome in non-tumour cases are diverse. In several cases, especially those with mild symptomatology, it has been suggested that the cause of the inappropriate TSH secretion is selective resistance to the action of thyroid hormones at the pituitary thyrotroph (Gershengorn, 1981;Kourides et a!L, 1977;Elewaut et al, 1976;Gershengorn and Weintraub, 1975;Novogroder et a!., 1977;Sato et al, 1979).…”

Section: Discussionmentioning

confidence: 99%

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Hyperthyroidism due to inappropriate TSH secretion with associated hyperprolactinaemia—a case report and review of the literature

Spitz¹,

Sheinfeld²,

Glasser³

et al. 1984

Postgraduate Medical Journal

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SummaryA patient with inappropriate thyrotrophin (TSH) secretion is described. She initially presented with classical hyperthyroidism during pregnancy, responded to propylthiouracil and, subsequently, had a normal delivery. Hyperthyroidism persisted and 7 5 months later a subtotal thyroidectomy was performed. After a further 16 months, mild symptoms of hyperthyroidism recurred. She again responded to propylthiouracil, but developed galactorrhoea. At that stage, it was noted that she had persistently elevated circulating TSH in the presence of elevated T4 and T3 levels. Her symptomatology was mild, although objective indices of thyroid activity, including pulse rate, BMR, sex hormone binding globulin and cholesterol, were indicative of hyperthyroidism. CT scan and tomography of the sella were normal.She had a markedly exaggerated TSH response to thyrotrophin releasing hormone (TRH). Basal TSH and responsiveness to TRH was suppressed by high dose dexamethasone. The TSH response to TRH was partially suppressed by exogenous T3, but there was no effect on basal TSH levels. TSH also decreased slightly with L-dopa and bromocriptine. Circulating TSH rose markedly during methimazole administration. TSH a and ,B subunits were elevated and appropriate for the high TSH. In addition, both subunits increased following TRH. The patient had basal hyperprolactinaemia with an impaired prolactin (PRL) response to TRH and metoclopramide. PRL suppressed with L-dopa and bromocriptine. The remaining anterior pituitary function was intact. Most of the laboratory findings argue against the presence of a TSH producing pituitary tumour and the most likely cause for inappropriate TSH secretion in this patient is selective resistance of the thyrotroph to thyroid hormones. A mild element of peripheral resistance might also be present. The hyperprolactinaemia could be related to lactotroph resistance to thyroid hormone.The complexities of treatment in this patient are stressed. Therapy was initially attempted with low dose dexamethasone, but this had no effect. T3 treatment produced an exacerbation of her symptomatology and did not influence basal TSH, thyroid hormones, or 131J uptake. Bromocriptine administration for 11 months partially suppressed basal TSH without influencing T3 and there was an increase in T4. Methimazole did decrease her T4 and T3, but TSH and PRL rose to even greater levels. Her hyperthyroidism was eventually controlled with an ablative dose of 1311. Thyroid hormone will be given in an attempt to suppress her TSH.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hyperthyroidism due to inappropriate TSH secretion with associated hyperprolactinaemia—a case report and review of the literature

Spitz¹,

Sheinfeld²,

Glasser³

et al. 1984

Postgraduate Medical Journal

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“…Thyroid hormone refractoriness (TR) is known as a rare disorder with impaired receptors to the hormone {Refetoff DeWind and DeGroot 1967;McKusick 1988). TR is usually divided into three categories; general {Refetoff, DeWind and DeGroot 1967;Bode, Danon, Weintraub, Maloof and Crawford 1973;Ohzeki, Egi, Egawa and Hachimori 1984), pituitary (Gershengorn and Weintraub 1975;Weintraub, Gershengorn and Kourides 1981;Sato, Saida, Suzuki, Tanaka and Ishiguro 1979), and peripheral (Kaplan, Swartz and Larsen 1981) types.…”

Section: Introductionmentioning

confidence: 99%

Refractoriness at Peripheral and Pituitary Receptors in General and Pituitary Types of Thyroid Hormone Resistance

Ohzeki

Hanaki²,

Motozumi³

et al. 1992

Horm Metab Res

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Patients with the general type (patient #1 and #2) and the selective pituitary type (#3) of thyroid hormone refractoriness (TR) were studied to clarify defects at peripheral and pituitary receptors. Products of T3 and TSH (n = 63) were calculated when T3 was above the normal limit (T3 > 1.8 ng/ml, 2.8 nmol/l) as one of the indices of pituitary resistance. Means of T3 (ng/ml) x TSH (mU/l) of patient #1 (mean; 40.8), #2 (15.0) and #3 (8.6) were significantly greater than patients with Graves' disease (2.1), suggesting pituitary refractoriness in the 3 patients. The products of patient #1 and #2 were also significantly larger than patient #3, demonstrating that the pituitary insensitivity in the latter (#3) was less than the former patients. Means of serum cholesterol in patients #1 and #2 were higher than patient #3 and patients with Graves' disease. Products of T3 (ng/ml) and cholesterol (mg/ml) (n = 28) in the patient #1 (541.9) and #2 (461.0) were significantly greater than the patient #3 (292.8) and the patients with Graves' disease (275.3). The results demonstrate generalized refractoriness in the patient #1 and #2 and selective pituitary resistance in the patient #3. It is suggested that our patient with the pituitary type (#3) had less severely affected receptors at the pituitary than our two patients with the general type. These results are consistent with the previous hypothesis that the pituitary type of TR is a partial form of this disease.

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“…Such values are found in 10% of women menopaused for 1 to 5 vears and presenting a climacteric svndrome. This frequency is certainly higher than Gershengorn & Weintraub 1975;Kourides et al 1977Kourides et al , 1980Novogroder et al 1977;Sato et al 1979;Mihailovic et al 1980;Spanheimer et al 1982), led us to examine whether postmenopausal women with borderline high circulating thyroid hormones present a TSH-dependent hyperthyroidism, suggestive of an impaired feedback mechanism.…”

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confidence: 98%

Mild hyperthyroidism with inappropriate secretion of TSH in postmenopausal women

Custro¹,

Scafidi²

1986

Acta Endocrinologica

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In a previous study on the function of the hypothalamus -pituitary -thyroid axis, about 10% of postmenopausal women with the climacteric syndrome were found to have borderline high values of T3 and T4 and signs of pituitary decreased sensitivity to the suppressive effect of increased thyroid hormones. The present report concerns 5 women in the first phase of their menopause who showed a mild hyperthyroidism under basal conditions and after suppression test with liothyronine. Each patient had borderline increased levels of serum total and free T4 and T3 and a marked TSH responsiveness to exogenous TRH.After liothyronine, the serum levels of T4, FT4, TSH and the responsiveness to TRH-test clearly decreased. These data suggest an inappropriate TSH secretion with a decreased pituitary sentitivity to thyroid hormones.These cases could represent a modification of the hypothalamus-pituitary-thyroid axis associated with that of the gonadal axis, secondary to the absence of rapid adaptation of neurotransmitters.In a previous work we reported functional altera¬ tions in the hvpothalamus-pituitarv-thvroid axis during the first phase of the menopause (Custro et al. 1982).In the present study we selected women with borderline high values of serum T3 and T4. Such values are found in 10% of women menopaused for 1 to 5 vears and presenting a climacteric svndrome. This frequency is certainly higher than Requests for reprints:

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A Case of The Syndrome of Inappropriate Secretion of TSH

Cited by 13 publications

References 6 publications

Hyperthyroidism due to inappropriate TSH secretion with associated hyperprolactinaemia—a case report and review of the literature

Hyperthyroidism due to inappropriate TSH secretion with associated hyperprolactinaemia—a case report and review of the literature

Refractoriness at Peripheral and Pituitary Receptors in General and Pituitary Types of Thyroid Hormone Resistance

Mild hyperthyroidism with inappropriate secretion of TSH in postmenopausal women

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