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Fang Y, Liu T, Hou H, Wang Z, Shan Z, Cao Y, Teng X. Resistance to thyroid hormone beta coexisting with papillary thyroid carcinoma—two case reports of a thyroid hormone receptor beta gene mutation and a literature review. Front Genet 2022; 13:1014323. [DOI: 10.3389/fgene.2022.1014323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
Graphical AbstractWhole exome sequencing.
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Yu C, Zhao J, Yao J, Wang H, Shang H, Zhang R, Cui Y, Wang L, Dong J, Liao L. Pituitary resistance to thyroid hormone caused by a novel mutation (H435A) in the thyroid hormone receptor beta: A case report. Medicine (Baltimore) 2018; 97:e10544. [PMID: 29794730 PMCID: PMC6392742 DOI: 10.1097/md.0000000000010544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE In patients with pituitary thyroid hormone resistance, the ability of the pituitary gland to detect (and down-regulate) the increase of triiodothyronine is selectively impaired, while the periphery remains sensitive to triiodothyronine levels, producing symptoms of peripheral thyrotoxicity. Subsequently, there is no feedback of pituitary production of thyroid-stimulating hormone (TSH), which is responsible for this hyperthyroidism. PATIENT CONCERNS We report a case of a 46-year-old Chinese woman diagnosed with a thyroid nodule, with normal thyroid function. She underwent conventional subtotal thyroidectomy, and replacement therapy (levothyroxine) was used for as convention. However, it was later proven that she had pituitary resistance to thyroid hormone, as supra-physiological doses of levothyroxine were required to normalize TSH levels, which resulted in peripheral thyrotoxicity. DIAGNOSES Based on the patient's symptoms, laboratory tests results, imaging examinations, and genetic analysis (which noted a gene mutation), a diagnosis of pituitary resistance to thyroid hormones was confirmed. INTERVENTIONS The dose of levothyroxine was adjusted periodically and β-adrenergic blocker was used as symptomatic treatment. OUTCOMES The outcome in the reported case has been satisfactory despite the persistence of non-suppressed TSH. LESSONS An inappropriate level of TSH should always be evaluated. We found a new mutation (H435A) of the thyroid hormone receptor beta gene, which allowed for the establishment of a definitive diagnosis.
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Affiliation(s)
- Changzhen Yu
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University of Traditional Chinese Medicine
| | - Junyu Zhao
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
| | - Jinming Yao
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
| | - Huanjun Wang
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
| | - Hongxia Shang
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
| | - Rui Zhang
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
| | - Yujiao Cui
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University of Traditional Chinese Medicine
| | - Likang Wang
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University of Traditional Chinese Medicine
| | - Jianjun Dong
- Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lin Liao
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University
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Liu Y, Qu K, Hai Y, Li X, Zhao L, Zhao C. SNP mutations occurring in thyroid hormone receptor influenced individual susceptibility to triiodothyronine: Molecular dynamics and site-directed mutagenesis approaches. J Cell Biochem 2017; 119:2604-2616. [PMID: 29024007 DOI: 10.1002/jcb.26425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/03/2017] [Indexed: 12/11/2022]
Abstract
The increasing evidences have suggested that expression of single nucleotide polymorphisms (SNP) coded thyroid hormone receptors (THR) generally are associated with individual susceptibility to chemicals. In the present research, multiple molecular dynamics simulations on four SNP mutants (G332R, T337Δ, G345R, and G347E) were performed to investigate the structural and dynamical altering, which could lead to a binding capability variation to triiodothyronine (T3). It proved the structures of two SNP mutants (G345R and T337Δ) occurring in the THR proteins had experienced conformational change to a great extend, which also led to a significant decreasing in binding ability with T3. In addition, two mutates (G345R and G347E) and wild type THR proteins were expressed and purified based on site-directed mutagenesis technology to test their binding abilities with T3 by fluorescence experiments. The fluorescence quenching efficiencies of two mutates displayed that the conjugation with T3 decreased with a significant rate in G345R system and a little rate in G347E system compared with its wild type. It was consistent with the molecular dynamic research that the SNP mutations did change structures of THR protein, and thereby decreased the binding behavior of T3 at different extent. The overall molecular-level look at the protein structure may provide the structural basis to explain how one amino acid change can create a ripple effect on the protein structures and eventually affect the binding affinity of the ligands, which maybe the first stage to understand how SNP mutation results in individual difference in susceptibility to variant chemicals.
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Affiliation(s)
- Yaquan Liu
- School of Pharmacy, Lanzhou University, Lanzhou, China
| | - Kaili Qu
- School of Pharmacy, Lanzhou University, Lanzhou, China
| | - Ying Hai
- School of Pharmacy, Lanzhou University, Lanzhou, China
| | - Xin Li
- College of Food and Bioengineering, Henan University of Science and Technology, Luoyang, China
| | - Lei Zhao
- Key Laboratory of Chemistry and Quality for Traditional Chinese Medicines of the University of Gansu Province, Gansu University of Chinese Medicines, Lanzhou, China
| | - Chunyan Zhao
- School of Pharmacy, Lanzhou University, Lanzhou, China
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Xing W, Liu X, He Q, Zhang Z, Jiang Z. BRAF V600E mutation contributes papillary thyroid carcinoma and Hashimoto thyroiditis with resistance to thyroid hormone: A case report and literature review. Oncol Lett 2017; 14:2903-2911. [PMID: 28928829 PMCID: PMC5588167 DOI: 10.3892/ol.2017.6486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/04/2017] [Indexed: 01/17/2023] Open
Abstract
Resistance to thyroid hormone (RTH) is a rare autosomal hereditary disorder characterized by increased serum thyroid hormone (TH) levels with unsuppressed or increased thyrotropin concentration. It remains unknown whether the coexistence of RTH with papillary thyroid carcinoma (PTC) and Hashimoto thyroiditis (HT) is incidental or whether it possesses a genetic or pathophysiological association. In the present study, a case of RTH with PTC and HT in an 11-year-old Chinese patient was examined and the clinical presentation of RTH with PTC was discussed. In addition, the possible associations between RTH, PTC and HT were determined. HT was confirmed in the patient using an autoimmune assay and thyroid ultrasound. RTH was diagnosed on the basis of clinical manifestations, laboratory information and gene analysis, and PTC was diagnosed according to histological results. Results of BRAFV600E mutation analysis were positive. A literature review of 14 cases of RTH with PTC was included for comparison. The present case report indicates an association of RTH with PTC and HT coexistence in the patient. Close follow-up, histological evaluation and BRAFV600E mutation detection should be performed in each RTH case with HT, since a persistent increase in TSH may be a risk factor for the development of thyroid neoplasm.
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Affiliation(s)
- Wanjia Xing
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Xiaohong Liu
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Zongjing Zhang
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Zhaoshun Jiang
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
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Aoyama M, Yamasaki S, Tsuyuguchi M. A case of resistance to thyroid hormone diagnosed after total thyroidectomy for thyroid cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 62:268-71. [PMID: 26399363 DOI: 10.2152/jmi.62.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This is a case of a woman who was diagnosed with resistance to thyroid hormone after total thyroidectomy for thyroid cancer. Preoperative laboratory examination revealed the syndrome of inappropriate secretion of TSH, however, the patient had no thyrotoxic symptoms and no family history. Based on the results of ultrasonography and fine needle aspiration, she was diagnosed with papillary thyroid carcinoma and underwent total thyroidectomy. After the surgery, she received L-T4 therapy, but her TSH levels remained elevated. MRI was performed on the brain, but no lesions were found in the pituitary gland. Therefore, she was tested for TRβ gene, and a previously defined mutation, P453S, was detected. Ultimately, she was diagnosed as RTH and treated with L-T4. In this case, the dose of L-T4 needed to be increased to suppress her TSH levels to the normal range or less, and to prevent stimulating malignant cells. Currently, her dose of L-T4 has been increased, and her TSH levels are still lower than normal, however, she has no thyrotoxic symptoms, recurrence or metastasis of thyroid cancer. The patient is currently under careful observation regarding her circulatory and physiological status. In addition, the results of treatment still need to be monitored and evaluated.
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Dumlu EG, Tokaç M, Öcal H, Durak D, Kara H, Kılıç M, Yalçın A. Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study. ULUSAL CERRAHI DERGISI 2015; 32:173-7. [PMID: 27528810 DOI: 10.5152/ucd.2015.3138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of bupivacaine and to compare the routes of administration of bupivacaine in the management of postoperative incision site pain after thyroidectomy. MATERIAL AND METHODS Consecutive patients who were planned for thyroidectomy surgery were randomized into three groups of 30 patients each: Group 1 (control group): standard thyroidectomy surgery without additional intervention; Group 2 (paratracheal infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was applied on the surgical area; Group 3 (subcutaneous infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was injected into the cutaneous, subcutaneous region and fascia of the surgical area. Postoperative pain was evaluated by a visual analog scale (VAS) at 1(st), 4(th), and 12(th) hours after thyroidectomy. Total daily requirement for additional analgesia was recorded. RESULTS The mean age of 90 patients was 44.37±13.42 years, and the female:male ratio was 62:28. There was no difference between study groups in terms of age, thyroid volume, TSH and T4 levels. VAS score of patients in paratracheal infiltration with bupivacaine group was significantly lower than control group patients at 1(st), 4(th) and 12(th) hours following thyroidectomy (p=0.030, p=0.033, p=0.039, respectively). The need for analgesics was significantly lower in both paratracheal infiltration and subcutaneous infiltration groups than the control group (86.7%, 83.0%, and 73.3%, respectively, p=0.049). CONCLUSIONS Intraoperative local bupivacaine application is effective in decreasing postoperative pain in patients with thyroidectomy.
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Affiliation(s)
- Ersin Gürkan Dumlu
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mehmet Tokaç
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Haydar Öcal
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Doğukan Durak
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Halil Kara
- Department of Pharmacology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mehmet Kılıç
- Department of General Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Abdussamed Yalçın
- Department of General Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Chen K, Xie Y, Zhao L, Zhao S, He H, Mo Z. A novel mutation of thyroid hormone receptor β in exon 10 in a case of thyroid hormone-resistant non-Hodgkin's lymphoma of the thyroid. Oncol Lett 2015; 9:614-618. [PMID: 25621029 PMCID: PMC4301484 DOI: 10.3892/ol.2014.2715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
Only a few previous studies have demonstrated an association between resistance to thyroid hormone (RTH) and thyroid cancer. The current study presents the case of a 67-year-old female who was referred to the Third Xiangya Hospital of Central South University with an enlargement of the neck that had grown gradually over two years and subsequently, rapidly enlarged over the two months prior to admission, alongside a slight sensation of shortness of breath. Laboratory data revealed a significantly increased level of thyroid-stimulating hormone (TSH), total triiodothyronine, total thyroxine, free triiodothyronine, free thyroxine, thyroprotein and thyroglobulin antibody; however, the levels of thyroperoxidase and TSH receptor antibody were within the normal ranges. A thyroid hormone suppression test revealed a TSH reduction of 32%, Magnetic resonance imaging of the pituitary gland was negative for abnormalities. The patient's thyroid pathology revealed a non-Hodgkin's lymphoma of the thyroid. CHOP + nimustine chemotherapy significantly reduced the clinical symptoms. The genetic analysis revealed a novel point mutation of the thyroid hormone receptor β (THRB) gene in exon 10 (g1680 G to A) in the 3'-untranslated region of the patient. To the best of our knowledge, this is the first case report of RTH with thyroid non-Hodgkin's lymphoma, which involved a mutation (g1680 G to A) in exon 10 of THRB.
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Affiliation(s)
- Ke Chen
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Yanhong Xie
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Liling Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Shaoli Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Honghui He
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhaohui Mo
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
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