Pituitary Hyperplasia and Overt Hypothyroidism Induced by Methimazole in an Adolescent Girl with Resistance to Thyroid Hormone Accompanying Hashimoto’s Thyroiditis: A Case Report
DOI:
https://doi.org/10.31584/jhsmr.20241055Keywords:
Hashimoto’s thyroiditis, overt primary hypothyroidism, pituitary hyperplasia, resistance to thyroid hormoneAbstract
We describe a 13-year-old girl who presented at her local hospital with a diffuse goiter and had discrepant thyroid function test (TFT) of elevated free T4 (FT4), free T3 (FT3) levels with mildly elevated thyroid-stimulating hormone (TSH) and a pituitary magnetic resonance imaging (MRI) report of a pituitary hyperplasia. She was referred to our hospital where a repeat TFT found low FT4 and high TSH levels, and high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis (HT) with overt primary hypothyroidism. The girl had a good response after daily 100 µg levothyroxine treatment for 8 months with decreased goiter size along with disappearance of the pituitary mass. However, her FT4 and FT3 levels were elevated while the TSH was in the high normal range, although at this time there were no signs of hyperthyroidism. A genetic study confirmed our provisional diagnosis that the patient had a p.Pro453Thr monoallelic loss-of-function mutation of the thyroid hormone receptor beta (THRB) gene, suggesting the diagnosis of coexisting resistance to thyroid hormone-β (RTHβ) and HT in this patient.
References
Radetti G, Maselli M, Buzi F, Corrias A, Mussa A, Cambiaso P, et al. The natural history of the normal/mild elevated TSH serum levels in children and adolescents with Hashimoto’s thyroiditis and isolated hyperthyrotropinaemia: a 3-year follow-up. Clin Endocrinol (Oxf) 2012;76:394-8.
Wasniewska M, Corrias A, Salerno M, Mussa A, Capalbo D, Messina MF, et al. Thyroid function patterns at Hashimoto’s thyroiditis presentation in childhood and adolescence are mainly conditioned by patients’ age. Horm Res Paediatr 2012;78:232-6.
Tagami T. An overview of thyroid function tests in subjects with resistance to thyroid hormone and related disorders. Endocr J 2021;68:509-17.
Concolino P, Costella A, Paragliola RM. Mutational landscape of resistance to thyroid hormone beta (RTHβ). Mol Diagn Ther 2019;23:353-68.
Ch’ng TW, Chin VL. Challenging diagnosis of thyroid hormone resistance initially as Hashimoto’s thyroiditis. J Pediatr Endocrinol Metab 2019;32:203-6.
Xie Z, Li C, An Y, Zhao D, Wang X. Thyroid hormone resistance syndrome due to a novel heterozygous mutation and concomitant Hashimoto’s thyroiditis: a pedigree report. J Int Med Res 2022;50:3000605221109398.
van Mullem A, van Heerebeek R, Chrysis D, Visser E, Medici M, Andrikoula M, et al. Clinical phenotype and mutant TRα1. N Engl J Med 2012;366:1451-3.
Wejaphikul K, Groeneweg S, Dejkhamron P, Unachak K, Visser WE, Chatterjee VK, et al. Role of leucine 341 in thyroid hormone receptor beta revealed by a novel mutation causing thyroid hormone resistance. Thyroid 2018;28:1723-6.
Parrilla R, Mixson AJ, McPherson JA, McClaskey JH, Weintraub BD. Characterization of seven novel mutations of the c-erbA beta gene in unrelated kindreds with generalized thyroid hormone resistance. Evidence for two “hot spot” regions of the ligand binding domain. J Clin Invest 1991;88:2123-30.
Beck-Peccoz P, Giavoli C, Lania A. A 2019 update on TSH-secreting pituitary adenomas. J Endocrinol Invest 2019;42:1401-6.
Gillis D, Volpe R, Daneman D. A young boy with a thyroid yo-yo. J Pediatr Endocrinol Metab 1998;11:467-70.
Sapkota S, Karn M, Sapkota S. Pituitary hyperplasia in childhood primary hypothyroidism: a review. Childs Nerv Syst 2021;37:749-62.
Akahori H, Usuda R. Graves’ disease coexisted with resistance to thyroid hormone: a case report. J Med Case Rep 2021;15:473.
Barkoff MS, Kocherginsky M, Anselmo J, Weiss RE, Refetoff S. Autoimmunity in patients with resistance to thyroid hormone. J Clin Endocrinol Metab 2010;95:3189-93.
Gavin C, Meggison H, Ooi TC. Proposing a causal link between thyroid hormone resistance and primary autoimmune hypothyroidism. Medical Hypotheses 2008;70:1024-8.
Suntornlohanakul O, Sriphrapradang C. Pituitary hyperplasia mimicking thyrotropin-producing pituitary adenoma in the patient with resistance to thyroid hormone: a case report. Int J Neurosci 2021;132:207-11.
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