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Endocrine Abstracts (2014) 35 P263 | DOI: 10.1530/endoabs.35.P263

1Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey; 2Department of Pathology, Faculty of Medicine, Pamukkale University, Denizli, Turkey; 3Department of Medical Biology, Faculty of Medicine, Trakya University, Edirne, Turkey; 4Department of Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey; 5Department of Endocrinology and Metabolism, Faculty of Medicine, Trakya University, Edirne, Turkey.


Introduction: Resistance to thyroid hormone (RTH) is an inherited syndrome characterized by reduced responsiveness of target tissues to thyroid hormone (TH). It is characterized by high serum concentrations of free T4 (Ft4) and usually free T3 (Ft3) accompanied by normal or slightly high serum TSH concentrations. When RTH is suspected, the diagnosis should be confirmed by direct sequencing of the TR-β gene to identify mutations. Hurthle cell neoplasm (HCN) accounts for only about 3–10% of all differentiated thyroid cancers. To our knowledge; there isn’t any case reporting coexistence of HCN and RTH; so whe want to present this case.

Case report: A 38-year-old man presented with palpable goiter, tachycardia, nervousness, dysphagia and dyspnea. Thyroid function tests demonstrated a normal serum TSH of 1.21 μIU/ml but elevated fT3 of 6.00 pg\ml and fT4 of 2.44 ng\dl. He had normal α-subunit and partially suppressed TSH level by administration of incremental doses of L-T3, and positive TSH response to TRH stimulation. Genetical testing was ordered to confirm diagnosis. His thyroid ultrasound showed hypoechoic nodule measuring 24×18×34 mm. FNAB of the nodule was compatible with folliculer neoplasm. Histopathological examination after total thyroidectomy revealed HCN with a focus of 20 mm in the long diameter at the nodule location, showing capsular invasion. Radioiodine ablation (RA) was planned.Waiting for RA, he was treated with 300 mcq L-T4 and his TSH did not suppress, which will be also an important problem during the treatment and follow-up of HCN. The suppression of TSH could be difficult when HCN coexists with RTH. Increasing the dose of L-T4 can result in thyrotoxicosis without TSH suppression.

Conclusion: In conclusion, this is the first case of reporting coexistance of HCN and RTH; management is more challenging.

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