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An 18 years old, tall man presented for circumoral numbness, paresthesias, and hypocalcaemia, without carpopedal spasm or seizures. Previous medical history revealed bilateral cataract and osseous cysts on limbs at the age of 12. Hypocalcaemia resistant to calcium treatment and mild increased TSH levels were present. At diagnosis, we noticed a norm...
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Context 1
... and a normal echoic pattern of the thyroid. The subclinical hypothyroidism could be explained either by a borderline resistance to TSH or by a non-detectable non-autoimmune thyroid lesion. Levothyroxine 25 µg/day led to normalization of serum TSH levels. TRH 0.4 mg i.v. test was performed for more than 6 weeks after withdrawal of levothyroxine (Fig. 5). The TSH response to TRH showed a pattern of prolonged stimulation and delayed return to normal (240 minutes after TRH the TSH has still not returned to baseline). This is typical for tertiary (hypothalamic) insufficiency. There is a 5 fold increase of TSH over the basal levels, with delta of peak =20.3 mIU/L at 30 min, and persistent ...
Context 2
... negative autoimmune subclinical hypothyroidism must be distinguished in our patient from the possible thyroid resistance to TSH due to a defective Gsα protein (17). We also performed an intravenous TRH test for assessing the response of serum TSH, T 4 and T 3 in order to indirectly reveal normal TSH bioactivity (18,19), but the response of the thyroid hormones to TRH was not characteristic in our case (Fig 5). The TSH response to TRH and the subsequent T 4 and T 3 responses in resistance to TSH are not known (S. ...
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