resistance to thyroid hormone

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resistance to thyroid hormone



A rare autosomal dominant disorder in which patients have elevated serum levels of thyroid hormones but inappropriately elevated levels of thyroid stimulating hormone (TSH). TSH is normally suppressed by high thyroid hormone levels. Peripheral tissue responses to thyroid hormone are diminished in this syndrome although some patients are frankly thyrotoxic.
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Thyroid hormone resistance syndromes [by Refetoff S, Dumitrescu AM].
Ones likely laboratory errors are excluded, the differential diagnosis should be between TSH-secreting pituitary adenoma (TSHoma) and thyroid hormone resistance (THR) in inappropriate TSH secretion (2).
Syndromes of thyroid hormone resistance can often be confirmed by family history and thyroid testing of family members.
Thyroid hormone resistance may of may not be associated with mutations in thyroid receptor, specifically in the TR-[beta] gene.
It shows significant elevation of TSH in thyroid hormone resistance but blunted response in pituitary tumors.
Seventy percent of the children and 50 percent of the adults with thyroid hormone resistance also had ADHD, as determined by structured psychiatric interviews.
Usala SJ, Tennyson GE, Bale AE, et al: A base mutation of the c-erbA beta thyroid hormone receptor in a kindred with generalized thyroid hormone resistance.
4], thyroid hormone resistance syndromes, TSH-secreting pituitary adenoma, familial dysalbuminemic hyperthyroxinemia, amiodarone therapy, and primary hyperthyroidism with antibody interference in the TSH assay causing falsely increased TSH results.
151] therapy, External irradiation, Thyroidectomy Infiltrative disorders Neoplasia, leukemia, sarcoidosis, Hemochromatosis, amyloidosis, Mycobacterium tuberculosis infection, Pneumocystis carinii infection, cystinosis Reduced efficacy or Medications production of thyroid Lithium, amiodarone, hormone iodine/iodinated contrast, medium, antithyroid drugs *, phenylbutazone, sulfonamides interleukin alpha, interleukin-2 Thyroid hormone resistance, thyroiditis, iodine deficiency, Inherited defects in biosynthesis Thyroid agenesis/dysgenesis Secondary hypothyroidism Hypothalamic/pituitary disease * Include propylthiouracil, methimazole, perchiorate.
The occurrence of discordant thyroid function tests in a young woman with a history of ADHD does raise the possibility of thyroid hormone resistance (2).

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