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Use of bromocriptine in a patient with generalized resistance to thyroid hormone.
J Clin Endocrinol Metab. 1984 Apr; 58(4):731-5.JC

Abstract

A 50-yr-old man with a large goiter had elevated serum levels of T4 (22 micrograms/dl), T3 (228 ng/dl), and free T4 (6.6 ng/dl), a high 24-h 131I-thyroidal uptake (69%), and an elevated TSH level (3.6 microU/ml), as well as hyperresponsiveness of TSH to TRH (peak TSH, 47 microU/ml). Normal serum alpha-subunit concentrations and sella turcica films mitigated against the presence of a pituitary tumor. A normal basal metabolic rate and minimally elevated concentration of testosterone-estradiol binding globulin were consistent with generalized resistance to thyroid hormone. Mild lactotroph resistance was also present. The patient was given bromocriptine for 16 months (2.5-10 mg daily). Basal serum TSH levels decreased (less than 0.3-2 microU/ml), as did the TSH response to TRH; serum T4 levels (14-17 micrograms/dl); and 24-h 131I-thyroidal uptake (28%) were reduced. Serum T3 levels, however, changed little. The thyroid gland decreased to normal size, and the basal metabolic rate and testosterone-estradiol binding globulin remained normal. Bromocriptine was stopped for 4 months. Serum TSH increased to 4.5 microU/ml; T4 and T3 increased to 27 micrograms/dl and 328 ng/dl; the patient became clinically mildly hyperthyroid. Thus, bromocriptine in this patient was useful in decreasing TSH secretion and decreasing goiter size, while maintaining clinical euthyroidism. Only a small amount of TSH was necessary to maintain iodine uptake and thyroid hormone synthesis and secretion in a responsive thyroid gland. We speculate that this patient may be secreting a highly bioactive form of TSH and/or have increased thyroid sensitivity to TSH.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

6699135

Citation

Bajorunas, D R., et al. "Use of Bromocriptine in a Patient With Generalized Resistance to Thyroid Hormone." The Journal of Clinical Endocrinology and Metabolism, vol. 58, no. 4, 1984, pp. 731-5.
Bajorunas DR, Rosner W, Kourides IA. Use of bromocriptine in a patient with generalized resistance to thyroid hormone. J Clin Endocrinol Metab. 1984;58(4):731-5.
Bajorunas, D. R., Rosner, W., & Kourides, I. A. (1984). Use of bromocriptine in a patient with generalized resistance to thyroid hormone. The Journal of Clinical Endocrinology and Metabolism, 58(4), 731-5.
Bajorunas DR, Rosner W, Kourides IA. Use of Bromocriptine in a Patient With Generalized Resistance to Thyroid Hormone. J Clin Endocrinol Metab. 1984;58(4):731-5. PubMed PMID: 6699135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of bromocriptine in a patient with generalized resistance to thyroid hormone. AU - Bajorunas,D R, AU - Rosner,W, AU - Kourides,I A, PY - 1984/4/1/pubmed PY - 1984/4/1/medline PY - 1984/4/1/entrez SP - 731 EP - 5 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 58 IS - 4 N2 - A 50-yr-old man with a large goiter had elevated serum levels of T4 (22 micrograms/dl), T3 (228 ng/dl), and free T4 (6.6 ng/dl), a high 24-h 131I-thyroidal uptake (69%), and an elevated TSH level (3.6 microU/ml), as well as hyperresponsiveness of TSH to TRH (peak TSH, 47 microU/ml). Normal serum alpha-subunit concentrations and sella turcica films mitigated against the presence of a pituitary tumor. A normal basal metabolic rate and minimally elevated concentration of testosterone-estradiol binding globulin were consistent with generalized resistance to thyroid hormone. Mild lactotroph resistance was also present. The patient was given bromocriptine for 16 months (2.5-10 mg daily). Basal serum TSH levels decreased (less than 0.3-2 microU/ml), as did the TSH response to TRH; serum T4 levels (14-17 micrograms/dl); and 24-h 131I-thyroidal uptake (28%) were reduced. Serum T3 levels, however, changed little. The thyroid gland decreased to normal size, and the basal metabolic rate and testosterone-estradiol binding globulin remained normal. Bromocriptine was stopped for 4 months. Serum TSH increased to 4.5 microU/ml; T4 and T3 increased to 27 micrograms/dl and 328 ng/dl; the patient became clinically mildly hyperthyroid. Thus, bromocriptine in this patient was useful in decreasing TSH secretion and decreasing goiter size, while maintaining clinical euthyroidism. Only a small amount of TSH was necessary to maintain iodine uptake and thyroid hormone synthesis and secretion in a responsive thyroid gland. We speculate that this patient may be secreting a highly bioactive form of TSH and/or have increased thyroid sensitivity to TSH. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/6699135/Use_of_bromocriptine_in_a_patient_with_generalized_resistance_to_thyroid_hormone_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jcem-58-4-731 DB - PRIME DP - Unbound Medicine ER -