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[Hyperthyroidism caused by non-neoplastic inappropriate TSH secretion].

A Agapito1, L Guerra, A Afonso

  • 1Unidade de Endocrinologia, Hospital Curry Cabral, Lisboa.

Acta Medica Portuguesa
|February 1, 1992
PubMed
Summary

This study details a rare case of hyperthyroidism caused by inappropriate thyroid-stimulating hormone (TSH) secretion. The condition, characterized by resistance to thyroid hormones, proved resistant to common treatments.

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Area of Science:

  • Endocrinology
  • Thyroidology
  • Hormone Physiology

Background:

  • Hyperthyroidism is a common endocrine disorder, typically caused by excessive thyroid hormone production.
  • Non-neoplastic inappropriate thyrotrophin secretion is a rare cause of hyperthyroidism, often presenting diagnostic challenges.

Observation:

  • A 31-year-old woman presented with symptoms suggestive of hyperthyroidism post-thyroidectomy.
  • Elevated serum levels of triiodothyronine (T3) and thyroid-stimulating hormone (TSH) persisted despite thyroid removal.
  • Further investigations revealed TSH levels that increased with thyrotropin-releasing hormone (TRH) stimulation and were only partially suppressed by triiodothyronine.

Findings:

  • The diagnostic workup indicated inappropriate TSH secretion, a condition stemming from thyrotroph resistance to thyroid hormones.

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  • Computerised axial tomography of the sellar region did not reveal any neoplastic lesions.
  • Pharmacological interventions, including bromocriptine and octreotide, failed to reduce TSH levels effectively.

    • Implications:

    • This case highlights the importance of considering rare causes of hyperthyroidism, such as inappropriate TSH secretion.
    • The resistance to standard therapies underscores the complexity of managing this condition.
    • Therapeutic decisions, like the use of 3,5,3'-triiodothyroacetic acid, may need to be carefully timed, considering factors such as pregnancy and breastfeeding.