Exp Clin Endocrinol Diabetes 2009; 117(1): 34-37
DOI: 10.1055/s-2008-1076712
Article

© Georg Thieme Verlag KG Stuttgart · New York

Thyroid Hormone Receptor Beta Gene Mutation (P453A) in a Family Producing Resistance to Thyroid Hormone

T. Bayraktaroglu 1 , J. Noel 2 , F. Alagol 1 , N. Colak 1 , N. M. Mukaddes 3 , S. Refetoff 2 , 4 , 5 , 6 , 7
  • 1Department of Internal Medicine, Division of Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
  • 2Department of Medicine, The University of Chicago, Chicago, Illinois, USA
  • 3Department of Child Psychiatry, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
  • 4Pediatrics, The University of Chicago, Chicago, Illinois, USA
  • 5The Committees on Molecular Medicine, The University of Chicago, Chicago, Illinois, USA
  • 6Genetics, The University of Chicago, Chicago, Illinois, USA
  • 7The JP Kennedy Mental Retardation and Developmental Disabilities Center, The University of Chicago, Chicago, Illinois, USA
Weitere Informationen

Publikationsverlauf

received 06.01.2008 first decision 15.03.2008

accepted 11.04.2008

Publikationsdatum:
17. Juni 2008 (online)

Abstract

Background: Resistance to thyroid hormone (RTH) is a dominantly inherited syndrome characterized by decreased responsiveness of target tissues to thyroid hormone. Two members of a Turkish family, a mother and son, had thyroid function tests suggestive of resistance to thyroid hormone (RTH).

Methods: The clinical presentation was, however, different. The mother (proposita) had palpitation, weakness, tiredness, nervousness, dry mouth and was misdiagnosed as having multinodular toxic goiter which was treated with antithyroid drugs and partial thyroidectomy. Her younger son had attention deficit hyperactivity disorder and primary encopresis, but normal intellectual quotient. Both had elevated serum iodothyronine levels with nonsuppressed thyrotropin.

Results: A mutation in one allele of the thyroid hormone receptor beta gene (P453A) was identified, providing a genetic confirmation for the diagnosis of RTH.

Conclusion: Mutational analysis of the TRß gene allows definitive diagnosis of RTH, potentially avoiding the need for protracted and expensive pituitary function testing.

References

  • 1 Refetoff S, Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone.  Endocr Rev. 1993;  14 348-399
  • 2 Beck-Peccoz P, Chatterjee VKK. The variable clinical phenotype in thyroid hormone resistance syndrome.  Thyroid. 1994;  4 225-232
  • 3 Refetoff S. Resistance to thyroid hormone (Chapter 81). In: Braverman LE, Utiger RE (eds) Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text, Ninth ed. Lippincott, Williams and Wilkins, Philadelphia 2005: 1109-1129
  • 4 Gloss B, Trost SU, Bluhm WF, Swanson EA, Clark R, Winkfein R, Janzen KM, Giles W, Chassande O, Samarut J, Dillmann WH. Cardiac ion channel expression and contractile function in mice with deletion of thyroid hormone receptor alpha or beta.  Endocrinology. 2001;  142 544-550
  • 5 Kahaly GJ, Matthews CH, Mohr-Kahaly S, Richards CA, Chatterjee VK. Cardiac involvement in thyroid hormone resistance.  J Clin Endocrinol Metab. 2002;  87 204-122
  • 6 Mamanasiri S, Yesil S, Dumitrescu AM, Liao XH, Demir T, Weiss RE, Refetoff S. Mosaicism of a Thyroid Hormone Receptor (TR) Beta Gene Mutation in Resistance to Thyroid Hormone (RTH).  J Clin Endocrinol Metab. 2006;  91 3471-3477
  • 7 Adams M, Matthews C, Collingwood TN, Tone Y, Beck-Peccoz P, Chatterjee KK. Genetic analysis of 29 kindreds with generalized and pituitary resistance to thyroid hormone: identification of thirteen novel mutations in the thyroid hormone receptor ß gene.  J Clin Invest. 1994;  94 506-515
  • 8 Pohlenz J, Weiss RE, Macchia PE, Pannain S, Lau IT, Ho H, Refetoff S. Five new families with resistance to thyroid hormone not caused by mutations in the thyroid hormone receptor ß gene.  J Clin Endocrinol Metab. 1999;  84 3919-3928
  • 9 Margotat A, Sarkissian G, Malezet-Desmoulins C, Peyrol N, Vlaeminck Guillem V, Wemeau JL, Torresani J. Identification de huit mutations dans le gène c-erbAß chez des patients atteints de résistance aux hormones thyroïdiennes. [Identification of eight new mutations in the c-erbAB gene of patients with resistance to thyroid hormone].  Ann Endocrinol (Paris). 2001;  62 220-225
  • 10 Aksoy DY, Gurlek A, Ringkananont U, Weiss RE, Refetoff S. Resistance to thyroid hormone associated with autoimmune thyroid disease in a Turkish family.  J Endocrinol Invest. 2005;  28 379-383
  • 11 Florkowski CM, Brownlie BE, Croxson MS, Manning P, Farrand S, Smith G, Potter HC, George PM. Thyroid hormone resistance: the role of mutational analysis.  Intern Med J. 2006;  36 738-741
  • 12 Liu J, Shi B. Study on TR beta gene mutation in a thyroid hormone resistance syndrome family.  Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2006;  23 423-426
  • 13 Weiss RE, Tunca H, Knapple WL, Faas FH, Refetoff S. Phenotype differences of resistance to thyroid hormone (RTH) in two unrelated families with identical mutations in the thyroid hormone receptor ß gene (R320C).  Thyroid. 1997;  7 35-38
  • 14 Reinhardt W, Jockenhövel F, Deuble J, Chatterjee VKK, Reinwein D, Mann K. Thyroid hormone resistance: variable clinical manifestations in five patients.  Nuklearmedizin. 1997;  36 250-255
  • 15 Shuto Y, Wakabayashi I, Amuro N, Minami S, Okazaki T. A point mutation in the 3,5,3′-triiodothyronine-binding domain of thyroid hormone receptor ß associated with a family with generalized resistance to thyroid hormone.  J Clin Endocrinol Metab. 1992;  75 213-217
  • 16 Ishay A, Dumitrescu A, Luboshitzky R, Rakover Y, Refetoff S. A new case of resistance to thyroid hormone caused by a de novo P453T Mutation in the thyroid hormone receptor gene in an israeli child.  Thyroid. 2003;  13 409-412
  • 17 Rivolta CM, Feijoo MC, Targovnik HM, Funes A. Identificatión de una transversión heterocigota 1337C>A (P453T) en el exón 10 del gen del receptor de hormonas tiroideas ß en una familia con resistencia a hormonas tiroideas.  Rev Arg Endocinol Metab. 2003;  40 13-22
  • 18 Wu SY, Sadow PM, Refetoff S, Weiss RE. Tissue responses to thyroid hormone in a kindred with resistance to thyroid hormone harboring a commonly occurring mutation in the thyroid hormone receptor beta gene (P453T).  J Lab Clin Med. 2005;  146 85-94
  • 19 Sato H, Sakai H. A family showing resistance to thyroid hormone associated with chronic thyroiditis and its clinical features: A case report.  Endocr J. 2006;  53 421-425
  • 20 Takeda K, Weiss RE, Refetoff S. Rapid localization of mutations in the thyroid hormone receptor-ß gene by denaturing gradient gel electrophoresis in 18 families with thyroid hormone resistance.  J Clin Endocrinol Metab. 1992;  74 712-719
  • 21 Refetoff S, Weiss RE, Wing JR, Sarne D, Chyna B, Hayashi Y. Resistance to thyroid hormone in subjects from two unrelated families is associated with a point mutation in the thyroid hormone receptor ß gene resulting in the replacement of the normal proline 453 with serine.  Thyroid. 1994;  4 249-254
  • 22 Ozata M, Suzuki S, Takeda T, Malkin DG, Miyamoto T, Liu R-T, Suzuki N, Silverberg JDH, Daneman D, DeGroot LJ. Functional analysis of a proline to serine mutation in codon 453 of the thyroid hormone receptor ß1 gene.  J Clin Endocrinol Metab. 1995;  80 3239-3245
  • 23 Collingwood TN, Adams M, Tone Y, Chatterjee VKK. Spectrum of transcriptional, dimerization, and dominant negative properties of twenty different mutant thyroid hormone ß-receptors in thyroid hormone resistance syndrome.  Mol Endocrinol. 1994;  8 1262-1277
  • 24 Usala SJ, Tennyson GE, Bale AE, Lash RW, Gesundheit N, Wondisford FE, Accili D, Hauser P, Weintraub BD. A base mutation of the c-erbAb thyroid hormone receptor in a kindred with generalized thyroid hormone resistance. Molecular heterogeneity in two other kindreds.  J Clin Invest. 1990;  85 93-100
  • 25 Usala SJ, Wondisford FE, Watson TL, Menke JB, Weintraub BD. Thyroid hormone and DNA binding properties of a mutant c-erbAß receptor associated with generalized thyroid hormone resistance.  Biochem Biophys Res Commun. 1990;  171 575-580
  • 26 Despres N, Grant AM. Antibody interference in thyroid assays: a potential for clinical misinformation.  Clin Chem. 1998;  44 440-454
  • 27 Refetoff S. Defects of thyroid hormone transport in serum. In: DeGroot LJ (ed) Thyroid Disease Manager. http://www.thyroidmanager.org 2007
  • 28 Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD. Thyrotropin-secreting pituitary tumors.  Endocr Rev. 1996;  17 610-838
  • 29 Hauser P, Zametkin AJ, Martinez P, Vitiello B, Matochik JA, Mixson AJ, Weintraub BD. Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone.  N Engl J Med. 1993;  328 997-1001
  • 30 Weiss RE, Stein MA, Trommer B, Refetoff S. Attention-deficit hyperactivity disorder and thyroid function.  J Pediatr. 1993;  123 539-545
  • 31 Rüsch A, Erway LC, Oliver D, Vennström B, Forrest D. Thyroid hormone receptor ß-dependent expression of a potassium conductance in inner hair cells at the onset of hearing.  Proc Natl Acad Sci (USA). 1998;  95 15758-15762
  • 32 Lorenzo C Di, Benninga MA. Pathophysiology of pediatric fecal incontinence.  Gastroenterology. 2004;  126 S33-40
  • 33 Brooks RC, Copen RM, Cox DJ, Morris J, Borowitz S, Sutphen J. Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal.  Ann Behav Med. 2000;  22 260-267
  • 34 Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population.  Ann Intern Med. 1994;  120 817-820

Correspondence

T. Bayraktaroglu

Department of Internal Medicine

Division of Endocrinology

Istanbul University

Istanbul Medical Faculty

Istanbul

Turkey

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