European Journal of Pediatrics

, Volume 171, Issue 7, pp 1133–1137 | Cite as

Sporadic congenital nonautoimmune hyperthyroidism caused by P639S mutation in thyrotropin receptor gene

  • Patrizia Agretti
  • Giuseppina De Marco
  • Martina Biagioni
  • Antonio Iannilli
  • Marco Marigliano
  • Aldo Pinchera
  • Paolo Vitti
  • Valentino Cherubini
  • Massimo TonaccheraEmail author
Case Report


Germline mutations of thyrotropin receptor (TSHR) gene determining a constitutive activation of the receptor were identified as a molecular cause of familial or sporadic congenital nonautoimmune hyperthyroidism (OMIM: 609152) (Nat Genet 7:396–401, 1994; N Engl J Med 332:150–154, 1995; Acta Endocrinol (Copenh) 100:512–518, 1982). We report the case of an Italian child subjected to the first clinical investigation at 24 months for an increased growth velocity; biochemical investigation showed high FT4 and FT3 serum values and undetectable thyrotropin in the absence of anti-thyroid antibodies; the thyroid gland was normal at ultrasound examination. Treatment with methimazole was started at the age of 30 months when her growth velocity was high and the bone age was advanced. DNA was extracted from her parents’, brother’s, and the patient’s blood. Exons 9 and 10 of the TSHR gene were amplified by polymerase chain reaction and subjected to direct sequencing. In proband, a heterozygous substitution of cytosine to thymine determining a proline to serine change at position 639 (P639S) of the TSHR was detected while the parents and brothers of the propositus, all euthyroid, showed only the wild-type sequence of the TSHR gene. This mutation was previously described as somatic in patients affected by hyperfunctioning thyroid nodules and as germline in a single Chinese family affected by thyrotoxicosis and mitral valve prolapse. This constitutively activating mutation is able to activate both the cyclic AMP and the inositol phosphate metabolic pathways when expressed in a heterologous system. In conclusion, we describe the first case of sporadic congenital nonautoimmune hyperthyroidism caused by de novo germinal P639S mutation of TSHR.


Sporadic congenital nonautoimmune hyperthyroidism Thyrotoxicosis Thyrotropin receptor Genetic analysis Germline mutation 



We are grateful to Ministero Dell’Universita’ e Della Ricerca Scientifica e Tecnologica and Ministero Della Sanita for funding.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Patrizia Agretti
    • 1
  • Giuseppina De Marco
    • 1
  • Martina Biagioni
    • 2
  • Antonio Iannilli
    • 2
  • Marco Marigliano
    • 2
  • Aldo Pinchera
    • 1
  • Paolo Vitti
    • 1
  • Valentino Cherubini
    • 2
  • Massimo Tonacchera
    • 1
    • 3
    Email author
  1. 1.Dipartimento di Endocrinologia e Metabolismo, Centro Eccellenza AmbiSENUniversità di PisaPisaItaly
  2. 2.S.O.D. Diabetologia PediatricaAzienda Ospedaliero-Universitaria Ospedali Riuniti AnconaAnconaItaly
  3. 3.Dipartimento di EndocrinologiaUniversità di PisaPisaItaly

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