ODP521 THYROID HORMONE RESISTANCE SYNDROME
Authors: Franco Katty Manrique , Manrique Helard 
Published: November 2022

Abstract

Introduction
The Thyroid hormone resistance syndrome is characterized by decreased tissue sensitivity to thyroid hormones. The incidence is about 1/50,000. We present two clinical cases of this disease. Clinical case 1A 59-year-old woman was evaluated for presenting palpitations for more than one year during exercise and rest. Also, she noticed heat even in the winter. Headache, hair loss, dry skin, capillary fragility were other complaints. She denies trembling in the hands, diarrhea and subcutaneous edemas. Cardiologist didn't find any cardiac alterations. Holter showed sinus tachycardia with average heart rate 84/min (59-135/min). No evidence of ectopic beats. Bisoprolol 5mg/day was indicated. Three years ago, in routine control "high thyroid hormones" was found. A year ago, one doctor said her "that she had altered thyroid hormones". Her daughter has hyperthyroidism recentely diagnosed. The physical exam showed uniform goiter. Not acanthosis. Slight distal tremor. Soft skin, no edemas. No exophthalmos. Her first blood profile showed: Total T3 1.15 (0.8-2), Total T4 14.34 (5.1-14.1) TSH 5.43 (0.27-4.2) Free T4 1.81 (0.93-1.7). The second one showed Free T3 3.25 (2-4.4), Free T4 1.94 (0.93-1.7), TSH 4.78 (0.27-4.2). The thyroid antibodies: TSI, AbTG and AbTPO were negative. Pituitary hormone profile was normal and according to the age. Pituitary MRI was normal. Clinical case 2 A 15-year-old male was evaluated for tachycardia, weight loss, nervousness, anxiety, and sweaty hands. Evaluated by Cardiology, the Holter monitor shows sinus tachycardia. In endocrinology department, the clinical evaluation showed only goiter and sweaty hands. Hepatic and renal profile were normal. Urinary and blood catecholamines and norepinephrine were normal. His first blood profile showed: Total T3 1.54 (0.8-2), Total T4 14.56 (5.1-14.1) Free T4 1.79 (0.93-1.7), TSH 0.54 (0.27-4.2). The second profile: Total T4 14.37 (5.1-14.1), Free T4 1.8 (0.93-1.7), TSH 0.48 (0.27-4.2). The thyroid antibodies: TSI, AbTG and AbTPO were negative. The thyroid ultrasound showed diffuse goiter. The pituitary MRI didn't show any lesions. He started treatment with Metoprolol every 24 hours. In both patients, we can´t made genetic testing because is not available in country.

Discussion
The thyroid profile in patients with thyroid hormone resistance syndrome is very characteristic: they present with elevated free thyroid hormones and normal or slightly elevated TSH. It is important to rule out alterations in transporter proteins, the presence in serum of a factor that interferes with hormonal determination, or a TSH-producing pituitary tumor. The diagnosis requires a high degree of suspicion. BibliographyMARBAN CALZON, Mercedes; GONZALEZ JIMENO, Alicia; GARCIA BERMEJO, Alba, BELMONTE PINTRE, Zaira. Perfil hormonal tiroideo poco frecuente. Síndrome de resistencia a hormonas tiroideas. Rev Pediatr Aten Primaria[online]. 2019, vol.21, n.81BERNAL J. Sindromes de resistencia a las hormonas tiroideas. Endocrinología y Nutrición. 2011. Vol 58, Num 4.1
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