Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas

Huang, Stephen A.; Tu, Helen M.; Harney, John W.; Venihaki, Maria; Butte, Atul J.; Kozakewich, Harry P.W.; Fishman, Steven J.; Larsen, P. Reed

doi:10.1056/nejm200007203430305

Cited by 540Thyroid Disorders and TreatmentsVascular Malformations and HemangiomasGrowth Hormone and Insulin-like Growth Factors

Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas

Huang, Stephen A., Tu, Helen M., Harney, John W., Venihaki, Maria, Butte, Atul J., Kozakewich, Harry P.W., Fishman, Steven J., Larsen, P. Reed·2000·New England Journal of Medicine

DOI 10.1056/nejm200007203430305

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Abstract

Hemangiomas are the most common tumors of infancy, with a prevalence of 5 to 10 percent among one-year-olds. They are characterized by rapid growth in the first year of life, followed by involution and gradual regression by adolescence.1,2 We recently treated a three-month-old infant with massive hepatic hemangiomas and primary hypothyroidism who needed very high doses of thyroid hormone to restore euthyroidism and normal thyrotropin secretion. This finding suggested that the rate of degradation of thyroid hormone was accelerated. We subsequently identified high levels of type 3 iodothyronine deiodinase activity in the hemangioma tissue. This selenoenzyme, normally present in . . .

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In a reported case, high serum rT3 (413 ng/mL) and high expression of D3 in hemangioma tissue were crucial to the diagnosis of severe hypothyroidism in an infant with hemangiomas.
“In that patient, the high serum levels of rT3 (413 ng/mL), followed by the demonstration of high expression of deiodinase type 3 (D3) in hemangioma tissue, were crucial to the diagnosis.”
From Can Reverse T3 Assay Be Employed to Guide T4 vs. T4/T3 Therapy in Hypothyroidism? (2019) · cites this paper as [22]
Increased type 3 deiodinase activity in large hemangiomas can cause increased metabolic clearance of administered LT4 and, with that, necessitate a higher LT4 dose.
“Increased type 3 deiodinase activity in large hemangiomas can cause increased metabolic clearance of administered LT4 and, with that, necessitate a higher LT4 dose (120–122).”
From Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology (2021) · cites this paper as [120]

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Acquired Hypothyroidism Caused by Infantile Hemangiomas
Chang, M. W. (2004) · Journal watch · doi:10.1056/jd200402040000003

Authors: Huang, S. A., Tu, H. M., Harney, J. W., Venihaki, M., Butte, A. J., Kozakewich, H. P. W., Fishman, S. J., & Larsen, P. R.
Affiliations: Boston Children's Hospital (US)
Brigham and Women's Hospital (US)
Children's Hospital (TN)
ORCID: Huang, Stephen A.
Venihaki, Maria
Butte, Atul J.
Kozakewich, Harry P.W.
Fishman, Steven J.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2000-07-20
Volume: 343
Issue: 3
Pages: 185-189
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm200007203430305
OpenAlex: W2320158996
Cited by: 540
References: 27
Citations by year: 2026: 12 · 2025: 12 · 2024: 12 · 2023: 5 · 2022: 17 · 2021: 30 · 2020: 22 · 2019: 27 · 2018: 22 · 2017: 32 · 2016: 28 · 2015: 20 · 2014: 31 · 2013: 23 · 2012: 26
FWCI: 10.44
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (DK 07699, R01DK044128, DK-44128, T32DK007529, T32DK007699, DK-07529)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Surgery › Vascular Malformations and Hemangiomas
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
Keywords: type 3 iodothyronine deiodinase, infantile hemangioma, hepatic hemangioma, primary hypothyroidism, severe hypothyroidism, selenoenzymes, thyroid hormone replacement, thyrotropin secretion
MeSH terms: Hemangioma, Humans, Hypothyroidism, Infant, Iodide Peroxidase, Liver Neoplasms, Magnetic Resonance Imaging, Male, Neoplasms, Multiple Primary, Retrospective Studies, Thyrotropin

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Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas

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