Central hypothyroidism or subclinical hyperthyroidism : can they be confused with each other?
SUMMARY: Isolated, adult-onset central hypothyroidism is very rare, and its diagnosis can be challenging. A 42-year-old patient was referred for evaluation of a 2.8 cm thyroid nodule. She referred symptoms that could be attributed to hypothyroidism and thyroid tests showed low TSH and normal-low levels of free T4. However, evaluation of the remaining pituitary hormones and pituitary MRI were normal, yet a radionuclide scanning revealed that the thyroid nodule was 'hot' and the tracer uptake in the remaining thyroid tissue was suppressed. Interpretation of these studies led to a misdiagnosis of subclinical hyperthyroidism and the patient was treated with radioiodine. Soon after treatment, she developed a frank hypothyroidism without appropriate elevation of TSH and the diagnosis of central hypothyroidism was made a posteriori. Long term follow-up revealed a progressive pituitary failure, with subsequent deficiency of ACTH and GH. This case should alert to the possibility of overlooking central hypothyroidism in patients simultaneously bearing primary thyroid diseases able to cause subclinical hyperthyroidism.
LEARNING POINTS: Although rarely, acquired central hypothyroidism can occur in the absence of other pituitary hormone deficiencies. In these cases, diagnosis is challenging, as symptoms are unspecific and usually mild, and laboratory findings are variable, including low, normal or even slightly elevated TSH levels, along with low or low-normal concentrations of free T4. In cases with low TSH levels, the coexistence of otherwise common disorders able to cause primary thyroid hyperfunction, such as autonomous nodular disease, may lead to a misdiagnosis of subclinical hyperthyroidism.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:2020 |
|---|---|
| Enthalten in: |
Endocrinology, diabetes & metabolism case reports - 2020(2020) vom: 05. Juli |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Boronat, Mauro [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Revised 27.02.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1530/EDM-20-0059 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM31274241X |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM31274241X | ||
| 003 | DE-627 | ||
| 005 | 20240229163108.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1530/EDM-20-0059 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1308.xml |
| 035 | |a (DE-627)NLM31274241X | ||
| 035 | |a (NLM)32698125 | ||
| 035 | |a (PII)EDM20-0059 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Boronat, Mauro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Central hypothyroidism or subclinical hyperthyroidism |b can they be confused with each other? |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a SUMMARY: Isolated, adult-onset central hypothyroidism is very rare, and its diagnosis can be challenging. A 42-year-old patient was referred for evaluation of a 2.8 cm thyroid nodule. She referred symptoms that could be attributed to hypothyroidism and thyroid tests showed low TSH and normal-low levels of free T4. However, evaluation of the remaining pituitary hormones and pituitary MRI were normal, yet a radionuclide scanning revealed that the thyroid nodule was 'hot' and the tracer uptake in the remaining thyroid tissue was suppressed. Interpretation of these studies led to a misdiagnosis of subclinical hyperthyroidism and the patient was treated with radioiodine. Soon after treatment, she developed a frank hypothyroidism without appropriate elevation of TSH and the diagnosis of central hypothyroidism was made a posteriori. Long term follow-up revealed a progressive pituitary failure, with subsequent deficiency of ACTH and GH. This case should alert to the possibility of overlooking central hypothyroidism in patients simultaneously bearing primary thyroid diseases able to cause subclinical hyperthyroidism | ||
| 520 | |a LEARNING POINTS: Although rarely, acquired central hypothyroidism can occur in the absence of other pituitary hormone deficiencies. In these cases, diagnosis is challenging, as symptoms are unspecific and usually mild, and laboratory findings are variable, including low, normal or even slightly elevated TSH levels, along with low or low-normal concentrations of free T4. In cases with low TSH levels, the coexistence of otherwise common disorders able to cause primary thyroid hyperfunction, such as autonomous nodular disease, may lead to a misdiagnosis of subclinical hyperthyroidism | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 2020 | |
| 650 | 4 | |a ACTH | |
| 650 | 4 | |a ACTH stimulation | |
| 650 | 4 | |a Adult | |
| 650 | 4 | |a Amnesia | |
| 650 | 4 | |a Arthralgia | |
| 650 | 4 | |a Asthenia | |
| 650 | 4 | |a Cortisol | |
| 650 | 4 | |a Depression | |
| 650 | 4 | |a Error in diagnosis/pitfalls and caveats | |
| 650 | 4 | |a FT4 | |
| 650 | 4 | |a Fatigue | |
| 650 | 4 | |a Female | |
| 650 | 4 | |a Fine needle aspiration biopsy | |
| 650 | 4 | |a GH | |
| 650 | 4 | |a Glucocorticoids | |
| 650 | 4 | |a Goitre | |
| 650 | 4 | |a Hydrocortisone | |
| 650 | 4 | |a Hyperthyroidism | |
| 650 | 4 | |a Hypophysitis | |
| 650 | 4 | |a Hypothyroidism | |
| 650 | 4 | |a IGF1 | |
| 650 | 4 | |a Insulin tolerance | |
| 650 | 4 | |a July | |
| 650 | 4 | |a Levothyroxine | |
| 650 | 4 | |a Oedema | |
| 650 | 4 | |a Oligomenorrhoea | |
| 650 | 4 | |a Pituitary | |
| 650 | 4 | |a Radioiodine | |
| 650 | 4 | |a Radionuclide therapy | |
| 650 | 4 | |a Sestamibi scan | |
| 650 | 4 | |a Spain | |
| 650 | 4 | |a TRH stimulation | |
| 650 | 4 | |a TSH | |
| 650 | 4 | |a Thyroid | |
| 650 | 4 | |a Thyroid nodule | |
| 650 | 4 | |a Thyroid ultrasonography | |
| 650 | 4 | |a Thyroxine (T4) | |
| 650 | 4 | |a White | |
| 773 | 0 | 8 | |i Enthalten in |t Endocrinology, diabetes & metabolism case reports |d 2013 |g 2020(2020) vom: 05. Juli |w (DE-627)NLM236279777 |x 2052-0573 |7 nnns |
| 773 | 1 | 8 | |g volume:2020 |g year:2020 |g day:05 |g month:07 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1530/EDM-20-0059 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 2020 |j 2020 |b 05 |c 07 | ||