Almacan B, Ozdemir N, Gürkan H, Gul S, Guldiken S, Hekimsoy Z
"Celal Bayar" University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
Division of Endocrinology and Metabolism, Manisa, Trakya University, Faculty of Medicine, Istanbul, Turkey.
Acta Endocrinol (Buchar). 2021 Jul-Sep;17(3):388-392. doi: 10.4183/aeb.2021.388.
Thyroid hormone resistance (RTH) is defined as a decrease in response to thyroid hormones in the target tissue. Most patients present with nonspecific findings. In this article, we aimed to represent a 22-year-old female patient who presented with palpitation, fatigue, and heat intolerance. She was thought to have thyroid hormone resistance and her genetic examination revealed NM_001128177.1 (THRβ): c.1034G > A (p.Gly345Asp) pathogenic variation in the THRβ gene.
A 22-year-old female patient presented with complaints of fatigue, heat intolerance and palpitations. She was taking Propranolol twice daily at admission. Her family history revealed hypothyroidism in her grandmother. Her physical examination results were as follows: height 160 cm, weight 65 kg, body mass index 25.4kg/m, body temperature 36.5°C, respiratory rate 18/min, heart rate 86 beats/min, blood pressure 120/80 mmHg. Her palms were sweaty. The heart sounds were normal, and no heart murmur was auscultated. The laboratory results were TSH: 5.31uU/mL, fT3: 6.83 pg/mL, and fT4: 2.43 ng/dL. THRβ gene mutation analysis was requested for our patient whose clinical history and laboratory results were compatible with thyroid hormone resistance. The pathogenic variation NM_001128177.1(THRβ):c.1034G>A (p.Gly345Asp) was detected after analysis.
A diagnosis of RTH requires high clinical suspicion and a genetic mutation analysis should be requested in the case of clinical suspicion. In this way, unnecessary anti-thyroid treatment can be prevented.
甲状腺激素抵抗(RTH)被定义为靶组织对甲状腺激素的反应性降低。大多数患者表现为非特异性症状。在本文中,我们旨在介绍一名22岁的女性患者,她出现心悸、疲劳和不耐热症状。她被认为患有甲状腺激素抵抗,其基因检测显示NM_001128177.1(THRβ):c.1034G>A(p.Gly345Asp),这是THRβ基因的致病性变异。
一名22岁女性患者主诉疲劳、不耐热和心悸。入院时她每天服用两次普萘洛尔。她的家族史显示其祖母患有甲状腺功能减退症。她的体格检查结果如下:身高160厘米,体重65千克,体重指数25.4kg/m,体温36.5°C,呼吸频率18次/分钟,心率86次/分钟,血压120/80mmHg。她的手掌多汗。心音正常,未闻及心脏杂音。实验室检查结果为促甲状腺激素(TSH):5.31uU/mL,游离三碘甲状腺原氨酸(fT3):6.83pg/mL,游离甲状腺素(fT4):2.43ng/dL。对于临床病史和实验室检查结果与甲状腺激素抵抗相符的该患者,我们进行了THRβ基因突变分析。分析后检测到致病性变异NM_001128177.1(THRβ):c.1034G>A(p.Gly345Asp)。
RTH的诊断需要高度的临床怀疑,临床怀疑时应进行基因突变分析。这样可以避免不必要的抗甲状腺治疗。