Abstract
Generalized resistance to thyroid hormone (GRTH) is a Syndrome characterized by elevated serum T4 and T3 levels, preservation of a TSH response to TRH and the absence of manifestations of thyroid hormone excess. In this communication we report the studies in a 6.3 years old boy, with height and weight in 50% percentile, bone age 6 years, with a large goiter of 50 gr. Ihe patient had received lugol for 5 months and stopped it a month before. Serum T4 level was 20 ng/dl, T3 339 ng/dl, free T4 5.6 ng/dl, negative antimicrosomal antibodies, TSH 1.0 uU/ml, TSH post TRH 11.5 uU/ml, prolactine 10.4 ng/ml, post TRH 43.1 ng/ml testosterone binding globulin (SHBG) 68.5 nmol/l, normal sella turcioa Rx. I131 uptake of 8, 32, 38% at 1, 24 and 48 hours respectively. Pulsatile nocturnal TSH secretion with a mean nocturnal_TSH surge (% increase in TSH frcm nadir) was 105% (95% confidence limits 50-300%) X day TSH 1.8 X night TSH 3.7. Thyroid gland didn't change during 10 months without therapy. The administration of T3 (80 ug/day) for 1 week produced a rise in serum T3 to 600 ng/dl, SHBG didn't change, and TSH response to TRH decrease only a 10%. Eight hours after BE 1.2 mg orally basal TSH daereased from 4.1 to 0.5 uU/ml, no significant change in T4 and T3 levels ware observed. Trying to decrease goiter size the patient was given Bromocriptine 2.5-5 mg/day for 4 months. The thyroid gland decreased to 25 g. No significant changes were observed in T4, T3, free T4, SHBG respense to TRH and 131I uptake. The Prl response_to TRH lowered 84%. The pulsatile TSH nocturnal secretion decreased X̄ day TSH 36%, X̄ night TSH 38%. The patient maintained the clinical euthyroidism with a growth rate of 7.3 cm/yr. Thus BC in this patient was useful in decreasing goiter size while maintaining clinical euthyroidism.
Chronic use of this dopeminergic agonist (BC) may be useful in certain patients with generalized resistance to thyroid hormone.
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Chiesa, A., Gruñeiro, L. 30 GENERALIZED RESISTANCE TO THYROID HORMONE IN A CHILDREN: USE OF PROMOCRIPTINE (BC). Pediatr Res 32, 254 (1992). https://doi.org/10.1203/00006450-199208000-00053
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DOI: https://doi.org/10.1203/00006450-199208000-00053
