Abstract
We assessed the 24-h behavior of circulating TSH and the dopaminergic control on TSH release in a postmenopausal woman, who had elevated levels of serum thyroid hormones and an inappropriately high concentration of serum TSH, indicating pituitary resistance to thyroid hormone action. The patient was found to have a daily profile of serum TSH similar to that of normal subjects, except for the persistently elevated 24 h levels, suggesting that alterations in thyroid hormone negative feedback control did not affect substantially circadian TSH rhythm. The acute administration of a dopamine antagonist drug (metoclopramide) resulted in a markedly elevated peak of serum TSH, similar both in the morning and in the evening. The chronic administration of a dopamine agonist drug (bromocriptine) reduced basal and TRH-stimulat-ed TSH, restored circadian TSH variations to lower levels, and normalized other thyroid function tests. Although the metoclopramide test results confirmed the existence of an increased dopaminergic inhibitory tone in nonneoplastic inappropriate secretion of TSH, the outcome of bromocriptine treatment indicated that the dopaminergic control over TSH release was not enough in this case of PRTH.
References
Emerson C.H., Utiger R.D. Hyperthyroidism and excessive thyrotropin secretion. N. Engl. J. Med. 287:328, 1972.
Gershengorn M.C., Weintraub B.D. Thyrotropin-induced hyperthyroidism caused by selective pituitary restistance to thyroid hormone. J. Clin. Invest. 56:633, 1975.
Kourides I.A., Pekonen F., Weintraub B.D Absence of thyroid binding immunoglobulins in patients with thyrotropin-mediated hyperthyroidism. J. Clin. Endocrinol. Metab. 51: 271, 1980.
Novogroder M., Utiger R., Boyar R., Levine L.S. Juvenile hyperthyroidism with elevated thyrotropin (TSH) and normal 24-hour FSH, LHGH and prolactin patterns. J. Clin. Endicrinol. Metab. 45:1053, 1977.
Sato T., Saida K., Suzuki V. A case of the syndrome of inappropriate secretion of TSH. Endocrinol. Jpn. 26:623, 1979.
Mihailovic V., Feller M.S., Kourides I.A., Utiger R.D. Hyperthyroidism due to excess of thyrotropin secretion: follow-up studies. J. Clin. Endocrinol. Metab. 59:1135, 1980.
Spanheimer R.G., Bar R.S., Hayford J.C. Hyperthyroidism caused by inappropriate thyrotropin hypersecretion. Arch. Intern. Med. 142:1283, 1982.
Custro N., Scafidi V. Mild hyperthyroidism with inappropriate secretion of TSH in postmenopausal women. Acta Endocrinol. (Copenh.) 111:204, 1986.
Custro N., Scafidi V. Transient mild hyperthyroidism with inappropriate TSH secretion in postmenopause. Follow-up of 4 cases. Minerva Endocrinol. 73:111, 1988.
Bernard I., Beauchamps G. Le cyclophenil dans les troubles de I’ovulation et de la menopause. Gaz. Med Franc. 78:3973, 1971.
Tong Y.L., Lee J.K., Halberg F. Number-weighed mean cosinor technique resolves phase-and frquency-synchronized rhythms with differing mesor and amplitudes. Int. J. Chronobiol. 7:365, 1973.
Persson B.H. The effect of bis (p-acetoxy-phenyl) cyclohexyliden-emethane (compound F 6066) on hormone excretion in postmenopausal women. Acta Soc. Med. Uppsala 70:1, 1965.
Custro N., Scaglione R. Circadian rhythm of TSH in adult men and women. Acta Endocrinol. (Copenh.) 95:1, 1980.
Scanlon M.F., Weightman D.R., Skale D.J., Mora B. Health M., Snow M.H., Hall R. Dopamine is a physiological regulator of thyrotropin (TSH) secretion in man. Clin. Endocrinol. (Oxf.) 10:7, 1979.
Scanlon M.F., Howells S., Peters J.R., Williams E.B., Richards F., Hall R., Picton Thomas J. Hyperprolactinemia, amenorrhoea and galactorrhea due to a pituitary thyrotropin adenoma. Clin. Endocrinol. (Oxf.) 23:35, 1985.
Scanlon M.F., Weetman A.P., Lewis M., Pourmand M., Rodriguez-Arnao M.D., Weightman D.R., Hall P. Dopaminergic modulation of circadian thyrotropin rhytms and thyroid hormone levels in euthyroid subjects. J. Clin. Endocrinol. Metab. 51: 1251, 1980.
Beck-Peccoz P., Piscitelli G., Cattaneo M.F., Faglia G. Successful treatment of hyperthyroidism due to nonneoplastic pituitary TSH hypersecretion with 3-5-3’ -triiotiroacetic acid (TRIAC). J. Endocrinol. Invest. 6:217, 1983.
Magee B., Sheridan B., Scanlon M.F., Atkinson A.B. Inappropriate thyrotropin secretion, increased dopaminergic tone and preservation of the diurnal rhythm in serum TSH. Clin. Endocrinol. (Oxf.) 24:209, 1986.
Faglia G., Beck-Peccoz P., Piscitelli G., Medri G. Inappropriate secretion of thyrotropin by the pituitary. Horm. Res. 26:79, 1987.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Custro, N., Scafidi, V. & Notarbartolo, A. Pituitary resistance to thyroid hormone action with preserved circadian rhythm of thyrotropin in a postmenopausal woman. J Endocrinol Invest 15, 121–126 (1992). https://doi.org/10.1007/BF03348676
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03348676