Selective Pituitary Resistance to Thyroid Hormone: Clinical Hyperthyroidism with High TSH on Levothyroxine Administration in I-131 Ablated Graves Disease

    January 2022 in “ Open Journal of Endocrine and Metabolic Diseases ”
    Ravi Moghe, Sarah Exley, Udaya M. Kabadi
    TLDR The woman was misdiagnosed with Graves Disease, leading to incorrect treatment, while she actually had Pituitary Resistance to Thyroid Hormone.
    This case report described a 70-year-old woman with symptoms of hyperthyroidism, including weight loss, palpitations, and hair loss, while on levothyroxine treatment for a misdiagnosed Graves Disease. The patient had undergone radioactive iodine ablation, which masked the presence of Pituitary Resistance to Thyroid Hormone (PRTH). Laboratory tests showed elevated Free T4, Free T3, and TSH levels, and a mutation in the thyroid hormone receptor beta gene 2 confirmed PRTH. The report highlighted the challenges in diagnosing and managing PRTH, emphasizing that the initial Graves Disease diagnosis was incorrect, leading to inappropriate treatment.
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