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Resistance to Thyroid Hormone Does Not Abrogate the Transient Thyrotoxicosis Associated with Gestation: Report of a Case

Units of Endocrinology (J.A.) and Genetics (T.K.), Hospital Divino Espirito Santo, 9500 Ponta Delgada, Azores-Portugal; and Departments of Medicine (K.D., R.S., S.R., R.E.W.) and Pediatrics (S.R.), University of Chicago, Chicago, Illinois 60637

Address all correspondence and requests for reprints to: Dr. João Anselmo, Endocrinology Unit, Hospital Divino Espirito Santo, 9500 Ponta Delgada-Azores, Portugal, or Dr. Roy E. Weiss, Thyroid Study Unit, MC 3090, University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637. E-mail: rweiss{at}medicine.bsd.uchicago.edu

Abstract

We report the occurrence of transient thyrotoxicosis during pregnancy in a subject with resistance to thyroid hormone. Before pregnancy, the subject was euthyroid, with normal serum TSH and elevated levels of free T₃ and free T₄ caused by a mutation in the TRß gene (R243Q). Beginning at the fourth week of gestation serum levels of free T₃ and T₄ increased in parallel with an increase in hCG. At 6–7 wk gestation she manifested hypermetabolic features, with mild nausea and vomiting. Peak levels of serum hCG and thyroid hormone concentrations were attained at 12 wk gestation, when serum TSH was fully suppressed. In the following weeks of gestation, thyroid hormone levels declined, with amelioration of the symptoms. A baby boy also affected with resistance to thyroid hormone harboring the same TRß gene mutation was born by normal vaginal delivery.

This article has been cited by other articles:

				J. Anselmo, D. Cao, T. Karrison, R. E. Weiss, and S. Refetoff Fetal Loss Associated With Excess Thyroid Hormone Exposure JAMA, August 11, 2004; 292(6): 691 - 695. [Abstract] [Full Text] [PDF]