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Anorexia nervosa with elevated serum TSH.

S Matsubayashi1, H Tamai, S Uehata

  • 1Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

Psychosomatic Medicine
|November 1, 1988
PubMed
Summary

Anorexia nervosa patients can exhibit unusual thyroid hormone levels, including elevated thyroid-stimulating hormone (TSH) with low T3 and free T4. These levels normalize with weight gain, suggesting a transient condition related to nutritional status.

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Area of Science:

  • Endocrinology
  • Nutritional Science
  • Metabolic Disorders

Background:

  • Thyroid dysfunction is frequently observed in patients with anorexia nervosa, often presenting with low or normal serum TSH.
  • The typical thyroid profile in starvation includes low triiodothyronine (T3) and free thyroxine (free T4) with suppressed TSH.

Observation:

  • This study reports four patients with anorexia nervosa who presented with paradoxically elevated serum TSH, low T3, and low free T4.
  • Thyrotropin-releasing hormone (TRH) testing revealed a delayed TSH peak but normal T3 responsiveness.
  • Patients were clinically euthyroid, lacked goiter, and had negative thyroid autoantibodies.

Findings:

  • The observed thyroid profile normalized after nutritional rehabilitation and weight gain.
  • These findings suggest either a latent transient primary hypothyroidism or a novel 'low T3 syndrome' with inappropriately high TSH secretion in these patients.

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  • The condition appears linked to the patients' pre-treatment nutritional state.

    • Implications:

    • This challenges the typical understanding of thyroid function during starvation in anorexia nervosa.
    • It highlights the need for careful interpretation of thyroid function tests in underweight patients.
    • Further research is warranted to elucidate the pathophysiology of this unique thyroid state and its relationship to malnutrition.