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Cited by 25Thyroid Disorders and TreatmentsPituitary Gland Disorders and TreatmentsHead and Neck Cancer Studies

Thyrotropin with decreased biological activity, a delayed consequence of cranial irradiation for nasopharyngeal carcinoma

Lee, K.-O., Persani, L., Tan, M., Sundram, F. X., Beck-Peccoz, P.·1995·Journal of Endocrinological Investigation
DOI 10.1007/bf03349814
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Abstract

Patients with TSH of decreased bioactivity have had previous surgery or no known cause (idiopathic). We describe eight patients with nasopharyngeal carcinoma treated with irradiation alone more than 5 yr ago. All had hypothalamic hypothyroidism with low FT4 and normal TSH. Iv TRH gave an exaggerated TSH response, with 60 min greater than 20 min values, without any FT4 or TT3 response at 24 h to the hypersecreted TSH. Radioiodine uptake in 2 patients before and after 3 days of bovine TSH increased from 13 to 31%, and 11 to 28%, respectively. Oral TRH given for 20 days to 5 patients showed a distinctive pattern in serum TSH, FT4 and TT3. Serum TSH rose markedly in the initial few days, dropped to moderate levels for a few days and finally dropped further towards normal values. In contrast, the FT4 and TT3 remained unchanged at hypothyroid levels in the first few days, despite the very elevated TSH; but increased to euthyroid levels and remained higher even while the serum TSH declined further. Direct measurement of TSH bioactivity in FRTL-5 cells in 3 patients showed low values of bioactivity to immunoactivity ratios: 0.4, < 0.2, and 0.35 (NR 0.6-2.1) which increased in 2 patients to 0.9 and 0.8 after 20 days TRH. Serum free alpha-subunit levels were low and unchanged (0.3 to 1.1 micrograms/L) with prolonged TRH. These observations suggest that cranial irradiation may cause hypothalamic hypothyroidism with TSH with decreased bioactivity, and that prolonged TRH administration may restore normal bioactivity.

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Crossref · 10.1007/bf03349814

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28 of 28 references verified0 citation errors · 0 not checkable

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  • In central hypothyroidism patients with high immunoreactive TSH, TSH elevations are similar to those generally found in subclinical or mild primary hypothyroidism and may lead to misdiagnosis.

    “In these cases, TSH elevations are similar to those generally found in subclinical or mild primary hypothyroidism and may lead to misdiagnosis [14-17, 30, 42].”

    From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [42]

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Related

Authors
Lee, K.-O., Persani, L., Tan, M., Sundram, F. X., & Beck-Peccoz, P.
Affiliations
  • National University of Singapore (SG)
  • IRCCS Istituto Auxologico Italiano (IT)
  • Singapore General Hospital (SG)
ORCID
Venue
Journal of Endocrinological Investigation
Publisher
Springer Science and Business Media LLC
Published
1995-11
Volume
18
Issue
10
Pages
800-805
ISSN
  • 0391-4097 (ISSN-L)
  • 1720-8386
DOI
10.1007/bf03349814
OpenAlex
W2161771829
Cited by
25
References
28
Citations by year
2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 2
FWCI
0.79
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Endocrinological Investigation (publishedVersion)
  • PubMed (publishedVersion)
  • National University of Singapore (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
Keywords
thyroid-stimulating hormone, cranial irradiation, nasopharyngeal carcinoma, hypothalamic hypothyroidism, triiodothyronine, thyrotropin-releasing hormone, radioiodine uptake, TSH alpha subunit, FRTL-5 cells, radiation-induced thyroid dysfunction
MeSH terms
Adult, Aged, Humans, Hypothalamic Diseases, Hypothyroidism, Kinetics, Middle Aged, Nasopharyngeal Neoplasms, Radiotherapy, Thyrotropin, Thyrotropin-Releasing Hormone, Thyroxine, Triiodothyronine

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