Coexistence of Autoimmune Hyper- and Hypothyroidism in a Kindred with Reduced Sensitivity to Thyroid Hormone

Abdellaoui, Yasmine; Magkou, Dimitra; Bakopoulou, Sofia; Zaharia, Ramona; Raffin-Sanson, Marie Laure; Cazabat, Laure

doi:10.1159/000506424

Cited by 1 publication

(1 citation statement)

References 18 publications

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“…In this study, four of five members in a family with RTHβ caused by K432I and concurrent AITD presented with overt thyrotoxicosis or overt hypothyroidism (Tables 1, 6, and 7). In the past, several RTHβ cases have been reported showing changes in thyroid function due to chronic thyroiditis (16)(17)(18), Graves' disease (19)(20)(21)(22)(23)(24)(25)(26), and painless thyroiditis (27,28), which required treatment.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune thyroid disease and thyroid function test fluctuations in patients with resistance to thyroid hormone

Okazaki-Hada

Nishihara

Hisakado

et al. 2022

European Journal of Endocrinology

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Objective Resistance to thyroid hormone beta (RTHβ) is an inherited syndrome caused by mutations in the thyroid hormone receptor β (THRB) gene. Patients with RTHβ typically have elevated thyroid hormone levels with non-suppressed serum thyroid-stimulating hormone (TSH). We aimed to elucidate the clinical, laboratory, and imaging findings of RTHβ patients and further to explore their association with THRB gene mutations. Design and methods We retrospectively reviewed the clinical charts and compared the clinical findings of 68 RTHβ patients (45 probands and 23 relatives) and 30 unaffected relatives in Kuma Hospital. Results Genetic testing revealed 35 heterozygous THRB gene mutations. Among all RTHβ patients, autoimmune thyroid disease (AITD) was detected in 42.1% of men and 40.9% of women, showing that the prevalence of AITD in affected males was significantly higher than in unaffected relatives (P = 0.019). During the follow-up of 44 patients, 13 patients (29.5%; 8 (42.1%) with AITD and 5 (20%) without AITD) temporarily showed thyroid function test results inconsistent with RTHβ. Two patients with the R383H mutation, which has little dominant-negative effect, temporarily showed normal thyroid hormone and TSH levels without AITD. Conclusions The frequency of AITD in male RTHβ patients was significantly higher compared to unaffected relatives. More than 20% of RTHβ patients temporarily showed laboratory findings atypical of RTHβ during their follow-up, and patients with AITD and specific THRB mutations were prone to display such findings. Therefore, genetic testing should be performed even for patients with fluctuations in thyroid function test results to avoid misdiagnosis and inappropriate treatment.

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