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[Hyperthyroidism at elevated thyreostimulin. A case with pituitary resistance to thyroid hormones]
X Brechignac1, C Broussolle, R Nove-Josserand
1Service de Médecine interne, Pavillon Giraud, Centre hospitalier Lyon-Sud, Pierre-Bénite.
Presse Medicale (Paris, France : 1983)
|June 18, 1994
Summary
This study presents a rare case of selective pituitary resistance to thyroid hormones in a young man with hyperthyroidism. Prolonged treatment is recommended due to relapse after discontinuation.
Area of Science:
- Endocrinology
- Thyroid Disorders
- Hormone Resistance Syndromes
Background:
- Thyroid hormone resistance syndromes present diagnostic and therapeutic challenges, characterized by elevated thyroid hormones and thyrostimulin.
- Distinguishing between peripheral and pituitary resistance is crucial for appropriate management.
Observation:
- A young adult male presented with clinical hyperthyroidism, elevated free triiodothyronine and free thyroxine, and normal thyroxine-binding globulin.
- Pituitary imaging and dynamic testing ruled out pituitary adenoma, suggesting non-tumoral inappropriate thyrostimulin secretion.
- The patient exhibited selective pituitary resistance to thyroid hormones, a condition rarely reported.
Findings:
- The patient's condition demonstrated a biological profile of simultaneous elevation of thyrostimulin and thyroid hormones.
- Clinical manifestations included hyperthyroidism, with potential goiter due to thyrostimulin's trophic effect.
- Treatment with beta-blockers and oral triiodothyronine was initiated, with prolonged therapy advised after relapse.
Implications:
- This case highlights the importance of recognizing selective pituitary resistance to thyroid hormones.
- Management strategies involve symptomatic treatment for hyperthyroidism and potential hormonal modulation.
- Long-term therapeutic approaches are essential for managing this rare endocrine disorder and preventing relapse.