Thyroid Hormone Resistance: A 17-Year Follow-up Case Report.

Cristina Giusto, Marina Passeri, Patrizia Sperti, Isabella Nardone, Sium Wolde Sellasie, Simona Zaccaria, Lucia Longo, Pietro Lo Deserto, Stefano Amendola, Luigi Uccioli
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Abstract

Background: Resistance to thyroid hormone is a rare syndrome characterized by peripheral resistance to thyroid hormones. It is caused by genetic dysfunction of thyroid receptor genes, with Thyroid hormone Receptor-beta (TRβ) being the most prevalent. Affected patients show high thyroid hormone levels and non-suppressed Thyroid-stimulating Hormone (TSH). Syndrome manifestations vary from hyperthyroidism to hypothyroidism depending on the specific mutation.

Case presentation: We, herein, describe the case of a 24-year-old female with a diagnosis of resistance to thyroid hormone from the age of 7. The main symptoms the patients complained about were headaches, palpitations, hyperidrosis, and frequent evacuations with severe underweight. The patient's blood test showed high FT3 and FT4 levels with a non-suppressed TSH. We performed a disease complications screening that revealed mild osteoporosis and normal cardiac activity (the patient was already treated with bisoprolol).

Conclusion: This case illustrates symptoms and complications of resistance to thyroid hormone syndrome, a rare and misdiagnosed condition. In this case report, we describe and explain longterm disease symptoms and their management. The long-term history of our patient's disease adds a more comprehensive evaluation of the syndrome and its consequences, contributing to new insights into the resistance to thyroid hormone syndrome and shedding light on personalized management of its manifestations.

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甲状腺激素抵抗:17 年随访病例报告
背景:甲状腺激素抵抗是一种罕见的综合征,其特征是外周对甲状腺激素的抵抗。它是由甲状腺受体基因的遗传功能障碍引起的,其中以甲状腺激素受体-β(TRβ)最为常见。患者表现为甲状腺激素水平高,促甲状腺激素(TSH)不受抑制。根据特定突变,综合征表现从甲状腺功能亢进到甲状腺功能减退不等:患者主诉的主要症状是头痛、心悸、多汗、频繁排便和体重严重不足。患者的血液检查显示 FT3 和 FT4 水平较高,TSH 不受抑制。我们进行了疾病并发症筛查,结果显示患者有轻度骨质疏松症,心脏活动正常(患者已接受比索洛尔治疗):本病例说明了甲状腺激素抵抗综合征的症状和并发症,这是一种罕见的误诊病症。在这份病例报告中,我们描述并解释了长期疾病症状及其治疗方法。患者的长期病史增加了对该综合征及其后果的更全面评估,有助于对甲状腺激素抵抗综合征有新的认识,并为其表现的个性化管理提供启示。
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