ANTI-IODOTHYRONINE AUTOANTIBODIES IN A GIRL WITH HYPERTHYROIDISM DUE TO PITUITARY RESISTANCE TO THYROID-HORMONES

被引:19
作者
CRINO, A [1 ]
BORRELLI, P [1 ]
SALVATORI, R [1 ]
CORTELAZZI, D [1 ]
RONCORONI, R [1 ]
BECKPECCOZ, P [1 ]
机构
[1] UNIV MILAN,OSPED MAGGIORE,IRCCS,IST SCI ENDOCRINE,I-20122 MILAN,ITALY
关键词
HYPERTHYROIDISM; PITUITARY RESISTANCE TO THYROID HORMONES; ANTI-IODOTHYRONINE AUTOANTIBODIES; BROMOCRIPTINE; TRIAC;
D O I
10.1007/BF03348675
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In the present study, we report the uncommon case of a 9.6-yr-old girl with circulating anti-T3 autoantibodies (T3-Ab) and hyperthyroidism due to inappropriate secretion of TSH (IST). The diagnosis of IST was based on the findings of normal TSH levels (2.4 mU/L) in the presence of high free T4 (28.2 pmol/L) and free T3 (FT3) levels, as measured by direct measurement methods based on "one-step" analog tracer (28.0 pmo/L) and "two-step" Lisophase(R) (13.3 pmo/L) techniques. The discrepancy between the two measurements suggested a methodological interference due to T3-Ab in "one-step" technique, being the "two-step" methodology unaffected by the presence of such autoantibodies. T3-Ab were documented by high nonspecific binding of serum to labeled T3 (38.0% vs 4.3 +/- 2.1% in controls). The clinical picture of hyperthyroidism, the qualitatively normal TSH responses to TRH and T3 suppression tests, the normal pituitary imaging and the values of some parameters of peripheral thyroid hormone action compatible with hyperthyroidism indicated that the patient was affected by pituitary resistance to thyroid hormones (PRTH). Chronic treatment with dopaminergic agent bromocriptine (7.5 mg/day) did not cause TSH secretion to be suppressed, while the administration of thyroid hormone analog TRIAC (1.4 mg/day) inhibited TSH release (from 2.4 to 0.2 mU/L). As a consequence, circulating thyroid hormone levels normalized and euthyroidism was restored. During TRIAC administration, FT3 levels, measured by "one-step" analog tracer technique, gave spuriously high values due to the methodological interference of T3-Ab (15.2 vs 4.3 pmol/L as measured by "two-step" Lisophase(R) technique). In conclusion, the present study indicates that a) the levels of circulating free thyroid hormones should be measured by methods unaffected by the presence of anti-iodothyronine autoantibodies in order to prevent either misdiagnosis of IST or, as in the present case, misinterpretation of the efficacy of TSH suppressive treatment, and b) it is mandatory to rule out the presence of such autoantibodies whenever IST is suspected.
引用
收藏
页码:113 / 120
页数:8
相关论文
共 36 条
  • [1] [Anonymous], 1959, RADIOGRAPH ATLAS SKE
  • [2] BECK-PECCOZ P, 1986, Journal of Clinical Immunoassay, V9, P211
  • [3] SUCCESSFUL TREATMENT OF HYPERTHYROIDISM DUE TO NON-NEOPLASTIC PITUITARY TSH HYPERSECRETION WITH 3,5,3'-TRIIODOTHYROACETIC ACID (TRIAC)
    BECKPECCOZ, P
    PISCITELLI, G
    CATTANEO, MG
    FAGLIA, G
    [J]. JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 1983, 6 (03) : 217 - 223
  • [4] BECKPECCOZ P, 1985, LANCET, V1, P1456
  • [5] EVALUATION OF FREE-THYROXINE METHODS IN THE PRESENCE OF IODOTHYRONINE-BINDING AUTOANTIBODIES
    BECKPECCOZ, P
    ROMELLI, PB
    CATTANEO, MG
    FAGLIA, G
    WHITE, EL
    BARLOW, JW
    STOCKIGT, JR
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1984, 58 (04) : 736 - 739
  • [6] SEX HORMONE-BINDING GLOBULIN MEASUREMENT IN PATIENTS WITH INAPPROPRIATE SECRETION OF THYROTROPIN (IST) - EVIDENCE AGAINST SELECTIVE PITUITARY THYROID-HORMONE RESISTANCE IN NONNEOPLASTIC IST
    BECKPECCOZ, P
    RONCORONI, R
    MARIOTTI, S
    MEDRI, G
    MARCOCCI, C
    BRABANT, G
    FORLONI, F
    PINCHERA, A
    FAGLIA, G
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1990, 71 (01) : 19 - 25
  • [7] TREATMENT OF HYPERTHYROIDISM DUE TO INAPPROPRIATE SECRETION OF THYROTROPIN WITH THE SOMATOSTATIN ANALOG SMS 201-995
    BECKPECCOZ, P
    MARIOTTI, S
    GUILLAUSSEAU, PJ
    MEDRI, G
    PISCITELLI, G
    BERTOLI, A
    BARBARINO, A
    RONDENA, M
    CHANSON, P
    PINCHERA, A
    FAGLIA, G
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1989, 68 (01) : 208 - 214
  • [8] CIRCULATING ANTITRIIODOTHYRONINE AUTOANTIBODIES IN 2 EUTHYROID PATIENTS - APPARENT LACK OF INTERFERENCE IN TOTAL T3 RADIOIMMUNOASSAY BASED ON 2ND ANTIBODY OR SOLID-PHASE SEPARATION TECHNIQUES
    BECKPECCOZ, P
    ROMELLI, PB
    FAGLIA, G
    [J]. JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 1983, 6 (05) : 333 - 340
  • [9] BRENNERGATI L, 1985, PITUITARY GLAND, P467
  • [10] FAMILIAL THYROID-HORMONE RESISTANCE
    COOPER, DS
    LADENSON, PW
    NISULA, BC
    DUNN, JF
    CHAPMAN, EM
    RIDGWAY, EC
    [J]. METABOLISM-CLINICAL AND EXPERIMENTAL, 1982, 31 (05): : 504 - 509