Hyperthyroid Goitre Due to Inappropriate TSH Secretion Successfully Treated With Dextro-Thyroxine

Abstract

B1-995) Ih J.A.,a 6 y e a r -o l d g i r l with small g o i t r e had e l e v a t e d l e v e l s o f T4, T 3 a s well cis TSH. Her high and w e i e h t were a t t h e 10th p e r c e n t i l e , bone age was delayed a b o u t 2 y e a r s but c l i n i c a l l y she was eutilyroid. Treatment w i t h t,h. r e s u l t e d i n T8H suppresion but s i n g s o f hyperthyroidism appeared. During t h e n e x t 3 y e a r s without any t r e a t m e n t T4, T 3 and bass1 TSH were s t i l l e l e v a t e d and TRH s t i m u l a t e d TSh i n c r e a s e d t o t h e hypothyroid range. A t t h e age o f 9 y e a r s c l i n i c a l symptams of hyperthyroidism were e v i d e n t , Hypothalamo-pituitary s t u d i e s were normal, t h e r e was no evidence f o r n i t u i t a r v tumor. A a r t i s s e l e c t i v e i t u i t a r y r e s i s t a n c e t o t h, was s u E p o s e d ,~i n c e 19SOPthe p a t i e n t~~-%~~~4 i n a dose o f 0.5mdd. Grsdual d e c r e a s e o f TSH l e v e l s was accompanied by r e d u c t i o n i n t h e s i z e of g o i t r e and a m e l i o r a t i o n o f c l i n i c a l symptoms o f hyperthyroidism, confirmed by n o r m a l i s a t i o n of WR, Temporary i n t e r r u pt i o n o f D-T4 t h e r a p y r e s u l t e d i n t h e i n c r e a s e o f a l l c l i n i c a l and biochemical a b a o r m a l i t i e s . To our knowl i d g e t h i s i s t h e f i ? s t case o f h e r t h roidism due t o 1 2 2 D-ri::. W h i l s t t h e l a s t 10 y e a r s ' l i t e r a t u r e u n a n i n o u s l y p o i n t s o u t t h e i n c r e a s e d p r e v a l e n c e o f s e r u a HCllA i n c h i l d r e n and y o u n g s t e r s u i l h i n s u l i n -d e p e n d e n t d i a l i e t c s n e l l i t u s (IOUH), t h e p r e d i c t i v e v a l u e o f o v e r t t h y r o i d d i s e a s e or such a b i o h u m o r a l n a r k c r i n t h e s e p a t i e n t s w i d e l y v a r i e s a c c o r d i n g t o t h e d i f f e r e n t A u t h a r s t sucl, a p a t t e r n was n o t c o n f i r m e d a t Lllc n c x l t e s t s . C o n c l u s i o n s : based on a l o n g i t u d i n a l s t u d y , o u r d a t a c o n f i r m t h a t t h e i n c r e a s e d p r e v a l e n c e o f HCllA i n IDOH c h i l d r e n i s n o t a s s o c i a t e d t o h i g h r i s k o f o v e r t t h yr o i d d i s e a s e . a t l e a s 1 i n Europc.C. Couprie", P.F. Bougneres, J.L. Chaussain. CONTINUOUS SUBCUTANEOUS GLUCAGON INFUSION IS AN EFFECTIVE MEAN OF INCREASING BLOOD GLUCOSE (BG) IN fNPERINSULINEMIC INFANTS.flyperinsulinemic infants develop severe hypoglycemia due to a major suppression of glucose production by the iiver. Treatnient of this condition is made difficult in a subset of patients by the limited efficacy of drugs, such as diazoxide or corticosteroids. The need for maintaining a large supply of glucose in these patients requires continuous nasogastric feeding and sometinies prolonged peripheral or central venous catheterization. We have used the subcutaneous infusion of glucagon via a small insulin pump in an attempt to maintain...

10 Years of Successful Treatment with Dextrothyroxine in a Girl with TSH-Induced Hyperthyroidism

“…As presented in part at the 19th and 26th Annual Meeting of ESPE in 1980 [12] and 1987 [13], we have treated this girl with the biologically less active dextro-isomer of thy roxine (DT4) in an attempt to suppress TSH secretion [14][15][16]. In the present paper we describe the favorable long-term effect of this treatment which led to a normal ization of the thyroid status and the disappearance of the goiter.…”