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Preclinical hyperthyroidism in multinodular goiter.

E Gemsenjäger, J J Staub, J Girard

    The Journal of Clinical Endocrinology and Metabolism
    |October 1, 1976
    PubMed
    Summary
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    In patients with multinodular goiter, the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was often blunted. This TRH unresponsiveness may indicate preclinical hyperthyroidism.

    Area of Science:

    • Endocrinology
    • Thyroidology
    • Internal Medicine

    Background:

    • Nontoxic multinodular goiter (MNG) is a common endocrine disorder.
    • Assessing thyroid reserve is crucial for managing MNG patients.
    • The thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) is a key indicator of thyroid function.

    Purpose of the Study:

    • To evaluate the TSH reserve in patients with nontoxic multinodular goiter.
    • To investigate the characteristics of patients with an absent TSH response to TRH.
    • To explore the impact of surgery on TRH responsiveness in MNG.

    Main Methods:

    • Administered 200 mcg TRH intravenously to 80 surgical patients with MNG.
    • Measured TSH, T4, FT4I, and T3 levels before and after TRH stimulation.

    Related Experiment Videos

  • Assessed I131-uptake, PBI131, and conversion rates.
  • Evaluated TRH responsiveness pre- and post-partial thyroidectomy.

    • Main Results:

    • TSH reserve was normal in 55 patients and elevated in 8.
    • 17 patients (21%) showed no TSH response to TRH (deltaTSH ≤ 1 μU/ml).
    • TRH unresponsiveness persisted in some patients despite euthyroid status and normal thyroid hormone levels; partial thyroidectomy led to recovery of TRH responsiveness in 12 subjects.

    Conclusions:

    • TRH unresponsiveness in MNG patients may represent a preclinical hyperthyroid state.
    • Autonomously functioning goiter compartments might maintain this condition.
    • Surgical intervention can restore normal TSH response to TRH in some MNG patients.