Selective Pituitary Thyroid Hormone Resistance Syndrome: A Case Report And Review Of The Literature

ObjectiveSelective pituitary thyroid hormone resistance syndrome is a rare disease.Therapy is usually necessary,but current choices are not completely satisfactory.Through the report of two cases and review of the related literature of the selective pituitary thyroid hormone resistance syndrome,including pathogenesis,clinical manifestation, diagnosis,differential diagnosis,treatment and prognosis,we can make more clearly of the early diagnosis and treatment of the disease and can also avoid misdiagnosis.MethodsWe describe the clinical data and treatment of two cases of selective pituitary thyroid hormone resistance syndrome,and review the literature to find out the similarity of all cases in aspect of etiological factors,mechanisms,clinical symptoms, diagnosis,treatment and prognosis.ResultsOne patient suffered from thyroid goiter.The thyroid function was:the levels of TT₃,TT₄,FT₃ and FT₄ were increased while TSH level was normal.Ultrasonic diagnosis displayed diffuse thyroid goiter and hyperthyroidism.There was also a node in the right side of thyroid.The emission computerized tomography of the thyroid exhibited the bilateralism of thyroid goiter and the rate of taking in technetium was high.The right side of thyroid probably had warm nodes.The result of magnetic resonance of pituitary illustrated that the pituitary and saddle area was normal.The other didn't suffer from thyroid goiter.The thyroid function was:the levels of TT₄ and FT₄ were increased and that of TSH was normal.Ultrasonic diagnosis elucidated the bilateralism of thyroid goiter and node.The result of the computer tomography of the thyroid was normal.The emission computerized tomography displayed the bilateralism of slight thyroid goiter and pilosity warm and cool nodes in thyroid.The magnetic resonance of pituitary demonstrated that the pituitary and saddle area was normal.One case followed up,the other had a treatment with bromocriptine.ConclusionsSelective pituitary thyroid hormone resistance syndrome was clinically a rare disease.Its exact pathogenesis was not clear.Because of its familial pathogenetic propensity,we supposed that it was associated with hereditary factor.Its hereditary method was the dominance of the autosome of the heredity.Recent researches have demonstrated that its pathogenesis was associated with thyroid hormone receptor 3. The treatment of this disease was the application of drugs,such as 3,5,3' -triiodothyroacetic acid and bromocriptine so as to control its symptoms.