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Usefulness of Thyrotropin (TSH)-Releasing Hormone Test and Nocturnal Surge of TSH for Diagnosis of Isolated Deficit of TSH Secretion

Department of Internal Medicine (N.Y., T.K., T.M.), Matsunami General Hospital, Kasamatsu, Gifu-Prefecture 5016062; Komaki Medical Clinic (T.K.), Gifu-City 5008865; The Second Department of Internal Medicine (T.T., K.H.), Kochi Medical School, Oko-Cho, Nankoku-City 7838505; and The Third Department of Internal Medicine (K.Y.), Gifu University School of Medicine, Tsukasa-Machi, Gifu-City, 5008076 Japan

Address correspondence and requests for reprints to: Noriyoshi Yamakita, M.D., Ph.D., Department of Internal Medicine, Matsunami General Hospital, Kasamatsu, Gifu-Prefecture 5016062, Japan. E-mail: nyamakita{at}matsunami-hsp.or.jp

Six patients with idiopathic isolated deficit of TSH secretion were examined and reported on. Their clinical symptoms and routine biochemical data were unclear and were not specific for hypothyroidism. Serum triiodothyronine, free thyroxine and TSH levels were slightly low or low-normal. Basal metabolic rate and thyroidal ¹²³I-uptake were also slightly low or low-normal. The response of serum TSH to TRH stimulation was blunted in all patients. No nocturnal surge of serum TSH level could be seen in any of the patients. Empty sella was revealed in three patients, and pituitary microadenoma in one patient via magnetic resolution imaging. Antihuman pituitary cytosol antibody was seen in five patients. Autoimmunity may have played a role in the pathogenesis of idiopathic isolated TSH deficiency.

Routine examination of thyroid function cannot easily detect this disease. TSH response to TRH stimulation and nocturnal surge of TSH should be examined when this disease is suspected.

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