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 67-year-old woman with a history of radioactive iodine ablation for presumed Graves' disease, who later exhibited symptoms of hyperthyroidism despite high TSH levels while on levothyroxine. The absence of pituitary abnormalities and genetic testing confirmed a diagnosis of pituitary resistance to thyroid hormone (PRTH), a rare disorder where the pituitary gland is resistant to thyroid hormone, leading to elevated TSH despite high levels of thyroid hormones. The patient's symptoms improved with a reduction in levothyroxine dosage, highlighting the importance of distinguishing PRTH from Graves' disease to avoid inappropriate treatment. The report emphasized that PRTH should not be managed like Graves' disease, as increasing thyroid hormone doses can exacerbate hyperthyroid symptoms.
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