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Hyperthyroidism Caused by Inappropriate Thyrotropin Hypersecretion: Studies in Patients With Selective Pituitary Resistance to Thyroid Hormone

Hyperthyroidism Caused by Inappropriate Thyrotropin Hypersecretion: Studies in Patients With... Abstract • We have identified the condition of thyrotropin (thyroid-stimulating hormone [TSH])-induced hyperthyroidism secondary to selective pituitary insensitivity to thyroid hormone in three patients. Each patient was clinically hyperthyroid, with elevated serum levels of thyroxine (T4) and triiodothyronine (T3) and detectable levels of serum TSH before therapy. After therapy, each patient had notably elevated TSH levels at a time that peripheral levels of thyroid hormones were in the hyperthyroid range. Before and after therapy, serum levels of TSH were suppressed by therapy with liothyronine sodium and were stimulated by protirelin (thyrotropin-releasing hormone) both before and after liothyronine and dexamethasone treatment. Dexamethasone therapy decreased the levels of TSH, protirelin-stimulated TSH, and circulating T4 and T3. Serum levels of glycoprotein α-subunit were 0.6 to 2.4 ng/ml, values considerably lower than found in patients with TSH-secreting pituitary tumors. We suggest that the frequency of TSH-induced hyperthyroidism secondary to pituitary insensitivity to thyroid hormone may be higher than presently indicated in the medical literature. (Arch Intern Med 1982;142:1283-1286) References 1. Weintraub BD, Gershengorn MC, Kourides IA, et al: Inappropriate secretion of thyroid-stimulating hormone. Ann Intern Med 1981;95:339-351.Crossref 2. Duello TM, Halmi NS: Pituitary adenoma producing thyrotropin and prolactin: An immunochemical and electron microscopic study. Virchows Arch Pathol Anat 1977;376:255-265.Crossref 3. Kourides IA, Ridgway EC, Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: Use of alpha and beta subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 1977;45:534-543.Crossref 4. Kourides IA, Pekonen F, Weintraub BD: Absence of thyroid-binding immunoglobulins in patients with thyrotropin-mediated hyperthyroidism. J Clin Endocrinol Metab 1980;51:271-274.Crossref 5. Smallridge RC, Wartofsky L, Dimond RC: Inappropriate secretion of thyrotropin: Discordance between the suppressive effects of corticosteroids and thyroid hormone. J Clin Endocrinol Metab 1979;48:700-705.Crossref 6. Yovos JG, Falko JM, O'Dorisio TM, et al: Thyrotoxicosis and a thyrotropin-secreting pituitary tumor causing unilateral exophthalmos. J Clin Endocrinol Metab 1981;53:338-343.Crossref 7. Refetoff S, DeGroot L, Benard B, et al: Studies of a sibship with apparent hereditary resistance to the intracellular action of thyroid hormone. Metabolism 1972;21:723-756.Crossref 8. Lamberg B, Rosengard S, Lewendhal K, et al: Familial partial peripheral resistance to thyroid hormones. Acta Endocrinol 1978;89:303-312. 9. Bode H, Danon M, Weintraub B, et al: Partial target organ resistance to thyroid hormones. J Clin Invest 1973;52:776-782.Crossref 10. Emerson CH, Utiger RD: Hyperthyroidism and excessive thyrotropin secretion. N Engl J Med 1972;287:328-333.Crossref 11. Mihailoric V, Feller MS, Kourides IA, et al: Hyperthyroidism due to excess thyrotropin secretion: Follow-up studies. J Clin Endocrinol Metab 1980;50:1135-1138.Crossref 12. Gershengorn MC, Weintraub BD: Thyrotropin-induced hyperthyroidism caused by selective pituitary resistance to thyroid hormone. J Clin Invest 1975;56:633-642Crossref 13. Elewaut A, Mussche M, Vermeulen A: Familial partial target organ resistance to thyroid hormones. J Clin Endocrinol Metab 1976:43:575.Crossref 14. Novogroder M, Utiger R, Boyar R, et al: Juvenile hyperthyroidism with elevated thyrotropin (TSH) and hormonal 24 hour FSH, LH, GH and prolactin patterns. J Clin Endocrinol Metab 1977;45:1053-1059.Crossref 15. Sato T, Saida K, Suzuki Y, et al: A case of the syndrome of inappropriate secretion of TSH. Endocrinol Jpn 1979;26:623-630.Crossref 16. Solid Phase HTSH Reagent System . Fullerton, Calif, Beckman Instruments, Inc, 1978. 17. Reichlin S, Utiger RD: Regulation of the pituitary-thyroid axis in man: Relationship of TSH concentration to concentration of free and total thyroxine in plasma. J Clin Endocrinol Metab 1967;27:251-255.Crossref 18. Ridgway EC, Weintraub BD, Cevallos JL, et al: Suppression of pituitary TSH secretion in the patient with a hyperfunctioning thyroid nodule. J Clin Invest 1973;52:2783-2792.Crossref 19. Samaan NA, Osborne BM, Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 1977;45:903-911.Crossref 20. Furth J, Moy P, Hershman JM, et al: Thyrotropic tumor syndrome. Arch Pathol Lab Med 1973;96:217-226. 21. Rosler A, Litvin Y, Hage C, et al: Familial hyperthyroidism due to inappropriate thyrotropin secretion successfully treated with triiodothyronine. J Clin Endocrinol Metab 1982;54:76-82.Crossref 22. Cotton GE, Gorman CA, Mayberry WE: Suppression of thyrotropin (h-TSH) in serums of patients with myxedema of varying etiology treated with thyroid hormones. N Engl J Med 1971;285:529-533.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hyperthyroidism Caused by Inappropriate Thyrotropin Hypersecretion: Studies in Patients With Selective Pituitary Resistance to Thyroid Hormone

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340200041011
Publisher site
See Article on Publisher Site

Abstract

Abstract • We have identified the condition of thyrotropin (thyroid-stimulating hormone [TSH])-induced hyperthyroidism secondary to selective pituitary insensitivity to thyroid hormone in three patients. Each patient was clinically hyperthyroid, with elevated serum levels of thyroxine (T4) and triiodothyronine (T3) and detectable levels of serum TSH before therapy. After therapy, each patient had notably elevated TSH levels at a time that peripheral levels of thyroid hormones were in the hyperthyroid range. Before and after therapy, serum levels of TSH were suppressed by therapy with liothyronine sodium and were stimulated by protirelin (thyrotropin-releasing hormone) both before and after liothyronine and dexamethasone treatment. Dexamethasone therapy decreased the levels of TSH, protirelin-stimulated TSH, and circulating T4 and T3. Serum levels of glycoprotein α-subunit were 0.6 to 2.4 ng/ml, values considerably lower than found in patients with TSH-secreting pituitary tumors. We suggest that the frequency of TSH-induced hyperthyroidism secondary to pituitary insensitivity to thyroid hormone may be higher than presently indicated in the medical literature. (Arch Intern Med 1982;142:1283-1286) References 1. Weintraub BD, Gershengorn MC, Kourides IA, et al: Inappropriate secretion of thyroid-stimulating hormone. Ann Intern Med 1981;95:339-351.Crossref 2. Duello TM, Halmi NS: Pituitary adenoma producing thyrotropin and prolactin: An immunochemical and electron microscopic study. Virchows Arch Pathol Anat 1977;376:255-265.Crossref 3. Kourides IA, Ridgway EC, Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: Use of alpha and beta subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 1977;45:534-543.Crossref 4. Kourides IA, Pekonen F, Weintraub BD: Absence of thyroid-binding immunoglobulins in patients with thyrotropin-mediated hyperthyroidism. J Clin Endocrinol Metab 1980;51:271-274.Crossref 5. Smallridge RC, Wartofsky L, Dimond RC: Inappropriate secretion of thyrotropin: Discordance between the suppressive effects of corticosteroids and thyroid hormone. J Clin Endocrinol Metab 1979;48:700-705.Crossref 6. Yovos JG, Falko JM, O'Dorisio TM, et al: Thyrotoxicosis and a thyrotropin-secreting pituitary tumor causing unilateral exophthalmos. J Clin Endocrinol Metab 1981;53:338-343.Crossref 7. Refetoff S, DeGroot L, Benard B, et al: Studies of a sibship with apparent hereditary resistance to the intracellular action of thyroid hormone. Metabolism 1972;21:723-756.Crossref 8. Lamberg B, Rosengard S, Lewendhal K, et al: Familial partial peripheral resistance to thyroid hormones. Acta Endocrinol 1978;89:303-312. 9. Bode H, Danon M, Weintraub B, et al: Partial target organ resistance to thyroid hormones. J Clin Invest 1973;52:776-782.Crossref 10. Emerson CH, Utiger RD: Hyperthyroidism and excessive thyrotropin secretion. N Engl J Med 1972;287:328-333.Crossref 11. Mihailoric V, Feller MS, Kourides IA, et al: Hyperthyroidism due to excess thyrotropin secretion: Follow-up studies. J Clin Endocrinol Metab 1980;50:1135-1138.Crossref 12. Gershengorn MC, Weintraub BD: Thyrotropin-induced hyperthyroidism caused by selective pituitary resistance to thyroid hormone. J Clin Invest 1975;56:633-642Crossref 13. Elewaut A, Mussche M, Vermeulen A: Familial partial target organ resistance to thyroid hormones. J Clin Endocrinol Metab 1976:43:575.Crossref 14. Novogroder M, Utiger R, Boyar R, et al: Juvenile hyperthyroidism with elevated thyrotropin (TSH) and hormonal 24 hour FSH, LH, GH and prolactin patterns. J Clin Endocrinol Metab 1977;45:1053-1059.Crossref 15. Sato T, Saida K, Suzuki Y, et al: A case of the syndrome of inappropriate secretion of TSH. Endocrinol Jpn 1979;26:623-630.Crossref 16. Solid Phase HTSH Reagent System . Fullerton, Calif, Beckman Instruments, Inc, 1978. 17. Reichlin S, Utiger RD: Regulation of the pituitary-thyroid axis in man: Relationship of TSH concentration to concentration of free and total thyroxine in plasma. J Clin Endocrinol Metab 1967;27:251-255.Crossref 18. Ridgway EC, Weintraub BD, Cevallos JL, et al: Suppression of pituitary TSH secretion in the patient with a hyperfunctioning thyroid nodule. J Clin Invest 1973;52:2783-2792.Crossref 19. Samaan NA, Osborne BM, Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 1977;45:903-911.Crossref 20. Furth J, Moy P, Hershman JM, et al: Thyrotropic tumor syndrome. Arch Pathol Lab Med 1973;96:217-226. 21. Rosler A, Litvin Y, Hage C, et al: Familial hyperthyroidism due to inappropriate thyrotropin secretion successfully treated with triiodothyronine. J Clin Endocrinol Metab 1982;54:76-82.Crossref 22. Cotton GE, Gorman CA, Mayberry WE: Suppression of thyrotropin (h-TSH) in serums of patients with myxedema of varying etiology treated with thyroid hormones. N Engl J Med 1971;285:529-533.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1982

References