Cargando…
Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report
BACKGROUND: Resistance to thyroid hormone (RTH) usually features a syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) without suppression of the typical high thyroid hormone levels. However, some patients with RTH show thyroid-stimulating hormone (TSH) suppression due to thyr...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814060/ https://www.ncbi.nlm.nih.gov/pubmed/31673293 http://dx.doi.org/10.1186/s13044-019-0072-2 |
_version_ | 1783462950531497984 |
---|---|
author | Nagamine, Tomoko Noh, Jaeduk Yoshimura Emoto, Naoya Kogai, Takahito Hishinuma, Akira Okajima, Fumitaka Sugihara, Hitoshi |
author_facet | Nagamine, Tomoko Noh, Jaeduk Yoshimura Emoto, Naoya Kogai, Takahito Hishinuma, Akira Okajima, Fumitaka Sugihara, Hitoshi |
author_sort | Nagamine, Tomoko |
collection | PubMed |
description | BACKGROUND: Resistance to thyroid hormone (RTH) usually features a syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) without suppression of the typical high thyroid hormone levels. However, some patients with RTH show thyroid-stimulating hormone (TSH) suppression due to thyrotoxicosis. We report a case of painless thyroiditis in a patient with RTH that was misdiagnosed as Graves’ disease because of TSH-suppressed thyrotoxicosis. CASE PRESENTATION: A sixteen-year-old boy consulted a local general physician for fatigue. He had a goiter, and biochemical analysis showed TSH < 0.1 μIU/mL, free triiodothyronine (FT3) of 2.70 pg/mL, and free thyroxine (FT4) of 3.6 ng/dL. He was diagnosed with Graves’ disease and was treated with 20 mg thiamazole. One year later, he was referred to the department of endocrinology because of SITSH. He was finally diagnosed with RTH due to the finding of a heterozygous missense mutation (methionine 334 threonine) in the thyroid hormone receptor β gene. Three years after cessation of thiamazole, his hyperthyroxinemia showed marked exacerbation with TSH suppression. We diagnosed him with painless destructive thyroiditis because of low technetium-99 m (Tc-99 m) uptake in the thyroid. Extreme hyperthyroxinemia was ameliorated, with a return to the usual SITSH levels, within 1 month without any treatment. CONCLUSION: The present case demonstrates that diagnosing RTH is difficult when patients show hyperthyroxinemia with complete suppression of TSH to undetectable levels, and the data lead to misdiagnosis of RTH as Graves’ disease. The initial diagnosis is important, and Tc-99 m scintigraphy is useful for the differential diagnosis of thyrotoxicosis accompanying RTH. |
format | Online Article Text |
id | pubmed-6814060 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-68140602019-10-31 Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report Nagamine, Tomoko Noh, Jaeduk Yoshimura Emoto, Naoya Kogai, Takahito Hishinuma, Akira Okajima, Fumitaka Sugihara, Hitoshi Thyroid Res Case Report BACKGROUND: Resistance to thyroid hormone (RTH) usually features a syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) without suppression of the typical high thyroid hormone levels. However, some patients with RTH show thyroid-stimulating hormone (TSH) suppression due to thyrotoxicosis. We report a case of painless thyroiditis in a patient with RTH that was misdiagnosed as Graves’ disease because of TSH-suppressed thyrotoxicosis. CASE PRESENTATION: A sixteen-year-old boy consulted a local general physician for fatigue. He had a goiter, and biochemical analysis showed TSH < 0.1 μIU/mL, free triiodothyronine (FT3) of 2.70 pg/mL, and free thyroxine (FT4) of 3.6 ng/dL. He was diagnosed with Graves’ disease and was treated with 20 mg thiamazole. One year later, he was referred to the department of endocrinology because of SITSH. He was finally diagnosed with RTH due to the finding of a heterozygous missense mutation (methionine 334 threonine) in the thyroid hormone receptor β gene. Three years after cessation of thiamazole, his hyperthyroxinemia showed marked exacerbation with TSH suppression. We diagnosed him with painless destructive thyroiditis because of low technetium-99 m (Tc-99 m) uptake in the thyroid. Extreme hyperthyroxinemia was ameliorated, with a return to the usual SITSH levels, within 1 month without any treatment. CONCLUSION: The present case demonstrates that diagnosing RTH is difficult when patients show hyperthyroxinemia with complete suppression of TSH to undetectable levels, and the data lead to misdiagnosis of RTH as Graves’ disease. The initial diagnosis is important, and Tc-99 m scintigraphy is useful for the differential diagnosis of thyrotoxicosis accompanying RTH. BioMed Central 2019-10-25 /pmc/articles/PMC6814060/ /pubmed/31673293 http://dx.doi.org/10.1186/s13044-019-0072-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Nagamine, Tomoko Noh, Jaeduk Yoshimura Emoto, Naoya Kogai, Takahito Hishinuma, Akira Okajima, Fumitaka Sugihara, Hitoshi Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title | Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title_full | Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title_fullStr | Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title_full_unstemmed | Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title_short | Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
title_sort | painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814060/ https://www.ncbi.nlm.nih.gov/pubmed/31673293 http://dx.doi.org/10.1186/s13044-019-0072-2 |
work_keys_str_mv | AT nagaminetomoko painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT nohjaedukyoshimura painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT emotonaoya painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT kogaitakahito painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT hishinumaakira painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT okajimafumitaka painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport AT sugiharahitoshi painlessdestructivethyroiditisinapatientwithresistancetothyroidhormoneacasereport |