Inappropriate secretion of thyrotropin: Discordance between the suppressive effects of corticosteroids and thyroid hormone

Robert Christian Smallridge, L. Wartofsky, R. C. Dimond

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

A 46-yr-old postmenopausal woman with acromegaly and hyperthyroidism had serum levels of TSH which were repeatedly measurable (2.0-3.4 μU/ml) and, therefore, inappropriately elevated. In addition, serum concentrations of the α-subunit were persistently elevated (10.7-18.8 ng/ml). Although there was a reciprocal relationship between serum T4 and TSH levels during treatment with antithyroid drugs, the concentration of α-subunit did not appear to vary with either T4 or TSH. Transsphenoidal surgery documented the presence of a pituitary adenoma but failed to cure either the acromegaly or the hyperthyroidism. While she was hyperthyroid, α-subunit fell to <1 μU/ml after prednisolone, but was unaffected by the administration of T3. α-Subunit was minimally suppressed by prednisolone and was not affected by T3. Secretion of TSH, α-subunit, and GH were unresponsive to TRH stimulation. When the patient became hypothyroid on antithyroid drugs, TRH increased TSH from 22.5 to >40 μU/ml, increased α-subunit from 14.6 to 21.8 ng/ml, and increased GH from 9 to 25 ng/ml. The patient was subsequently treated with both pituitary irradiation and 131I. Eighteen months later, she was euthyroid with serum TSH levels of 1.0 μU/ml, α-subunit levels of 4.3 ng/ml, and GH levels of 9 ng/ml. These data indicate that the patient had a pituitary tumor that secreted GH, TSH, and α-subunit and that there was a discordance between the feedback inhibitory effects of glucocorticoids and T3 on TSH secretion, and suggest that the tumor had an altered receptor for thyroid hormone.

Original languageEnglish (US)
Pages (from-to)700-705
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume48
Issue number4
StatePublished - 1979
Externally publishedYes

Fingerprint

Thyrotropin
Thyroid Hormones
Tumors
Adrenal Cortex Hormones
Hyperthyroidism
Antithyroid Agents
Thyroid Hormone Receptors
Acromegaly
Pituitary Neoplasms
Serum
Surgery
Glucocorticoids
Pituitary Irradiation
Irradiation
Feedback
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

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title = "Inappropriate secretion of thyrotropin: Discordance between the suppressive effects of corticosteroids and thyroid hormone",
abstract = "A 46-yr-old postmenopausal woman with acromegaly and hyperthyroidism had serum levels of TSH which were repeatedly measurable (2.0-3.4 μU/ml) and, therefore, inappropriately elevated. In addition, serum concentrations of the α-subunit were persistently elevated (10.7-18.8 ng/ml). Although there was a reciprocal relationship between serum T4 and TSH levels during treatment with antithyroid drugs, the concentration of α-subunit did not appear to vary with either T4 or TSH. Transsphenoidal surgery documented the presence of a pituitary adenoma but failed to cure either the acromegaly or the hyperthyroidism. While she was hyperthyroid, α-subunit fell to <1 μU/ml after prednisolone, but was unaffected by the administration of T3. α-Subunit was minimally suppressed by prednisolone and was not affected by T3. Secretion of TSH, α-subunit, and GH were unresponsive to TRH stimulation. When the patient became hypothyroid on antithyroid drugs, TRH increased TSH from 22.5 to >40 μU/ml, increased α-subunit from 14.6 to 21.8 ng/ml, and increased GH from 9 to 25 ng/ml. The patient was subsequently treated with both pituitary irradiation and 131I. Eighteen months later, she was euthyroid with serum TSH levels of 1.0 μU/ml, α-subunit levels of 4.3 ng/ml, and GH levels of 9 ng/ml. These data indicate that the patient had a pituitary tumor that secreted GH, TSH, and α-subunit and that there was a discordance between the feedback inhibitory effects of glucocorticoids and T3 on TSH secretion, and suggest that the tumor had an altered receptor for thyroid hormone.",
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N2 - A 46-yr-old postmenopausal woman with acromegaly and hyperthyroidism had serum levels of TSH which were repeatedly measurable (2.0-3.4 μU/ml) and, therefore, inappropriately elevated. In addition, serum concentrations of the α-subunit were persistently elevated (10.7-18.8 ng/ml). Although there was a reciprocal relationship between serum T4 and TSH levels during treatment with antithyroid drugs, the concentration of α-subunit did not appear to vary with either T4 or TSH. Transsphenoidal surgery documented the presence of a pituitary adenoma but failed to cure either the acromegaly or the hyperthyroidism. While she was hyperthyroid, α-subunit fell to <1 μU/ml after prednisolone, but was unaffected by the administration of T3. α-Subunit was minimally suppressed by prednisolone and was not affected by T3. Secretion of TSH, α-subunit, and GH were unresponsive to TRH stimulation. When the patient became hypothyroid on antithyroid drugs, TRH increased TSH from 22.5 to >40 μU/ml, increased α-subunit from 14.6 to 21.8 ng/ml, and increased GH from 9 to 25 ng/ml. The patient was subsequently treated with both pituitary irradiation and 131I. Eighteen months later, she was euthyroid with serum TSH levels of 1.0 μU/ml, α-subunit levels of 4.3 ng/ml, and GH levels of 9 ng/ml. These data indicate that the patient had a pituitary tumor that secreted GH, TSH, and α-subunit and that there was a discordance between the feedback inhibitory effects of glucocorticoids and T3 on TSH secretion, and suggest that the tumor had an altered receptor for thyroid hormone.

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