Abstract
Isolated TSH deficiency is rare. The diagnosis is based on (i) symptoms and signs of thyroid hormone deficiency, (ii) demonstration of an absent or impaired TSH response to TRH and (iii) other pituitary hormones remaining intact. We report a 60-year-old female in whom isolated TSH deficiency was found, with a free thyroxine - 7.0 pmol/L (11–20), total triiodothyronine level -1.5 nmol/L (1.1–2.6) and thyroid stimulating hormone - 0.87 mU/L (0.38–4.3). A TRH test on two separate occasions demonstrated an inappropriately low TSH response. Computed assisted tomography revealed a partially empty sella and other pituitary hormones were demonstrated to be intact. We were unable to detect pituitary antibodies using indirect immunofluorescence on sections of monkey pituitary. Treatment with thyroxine improved this patient’s symptoms and suppressed the TSH further.
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Spencer CA., Schwarzbein D., Guttler R.B., LoPresti J.S., Nicoloff J.T. Thyrotropin (TSH)–releasing hormone stimulation test responses employing third and fourth generation TSH assays. J. Clin. Endocrinol. Metab. 76: 494, 1993.
Nicoloff J.T., Spencer C.A. The use and misuse of sensitive thyrotropin assays. J. Clin. Endocrinol. Metab 71: 553, 1990.
Boehm T.M., Dimond R.C., Wartofsky L. Isolated thyrotropin deficiency with thyrotropin-releasing-hormone induced TSH secretion and thyroidal release. J. Clin. Endocrinol. Metab. 43: 1041, 1976.
Shuman C.R. Hypothyroidism due to thyrotropin deficiency without other manifestations of hypopituitarism. J. Clin. Endocrinol. Metab. 13: 795, 1953.
Sampson M.C., Rose E., Herbert E. Solitary (monotropic) thyrotropin deficiency with secondary hypothyroidism. Am. J. Med. 17: 871, 1954.
Lohrenz F.N., Fernandez R., Doe R.P. Isolated thyrotropin deficiency: review and report of three cases. Ann. Int. Med. 60: 990, 1964.
Odell W.D. Isolated deficiencies of anterior pituitary hormones. JAMA 197: 1006, 1966.
Sawin C.T., McHugh J.E. Isolated lack of thyrotropin in man. J. Clin. Endocrinol. Metab. 26: 955, 1966.
Miyai K., Azukizawa M., Kumahara Y. Familial isolated thyrotropin deficiency with cretinism. N. Engl. J. Med. 285: 1043, 1971.
Hayashizaki Y., Hiraoka Y., Tatsumi K., Hashimoto T., Furuyama J., Miyai K., Nishijo K., Matsuura M., Kohno H., Labbe A. Deoxyribonucleic acid analyses of five families with familial inherited thyroid stimulating hormone deficiency. J. Clin. Endocrinol. Metab. 71: 792, 1990.
Nygren A., Rojdmark S. Isolated thyrotropin deficiency in a man with narcoleptic attacks. Acta Med. Scand. 212: 175, 1982.
Burke C.W., Rees L.H., Bottazzo G.F., Mashiter K., Bitensky L., Moore R.A. Isolated ACTH deficiency and TSH deficiency in the adult. J. R. Soc. Med. 72: 328, 1979.
Gupta M.P., Kim S., Kang J., Sherman L., Kolodny H.D., Hamby R.I. Isolated TSH deficiency presenting as myxedema heart disease. JAMA 217: 205, 1971.
Lee H.B., Faiman C. Isolated thyrotropin deficiency due to a pituitary tumour. Can. Med. Assoc. J. 116: 520, 1977.
Komatsu M., Kondo T., Yamauchi K., Yokokawa N., Ichikawa K., Ishihara M., Aizawa T., Yamada T., Imai Y., Tanaka K., Taniguchi K., Watanabe T., Takahashi Y. Antipituitary antibodies in patients with the primary empty sella syndrome. J. Clin. Endocrinol. Metab. 67: 633, 1988.
Vannelli S., Conrieri M., Tosi C., Fedele A., Giordanino S., Elena M.G., Murru P.C. Description of a case with empty sella and isolated TSH deficiency. Min. Pediatr. 44: 43, 1992.
Merenich J.A., McDermott M.T., Kidd G.S. Transient isolated thyrotropin deficiency in the postpartum period. Am. J. Med. 86: 361, 1989.
Kumar S. Isolated thyroid-stimulating hormone(TSH) deficiency following childbirth. Proc. R. Soc. Med. 59: 1281, 1966.
Bottazzo G.F., Mclntosh C., Stanford W., Preece M. Growth hormone cell antibodies and partial growth hormone deficiency in a girl with Turners syndrome. Clin. Endocrinol. (Oxf.) 12: 1, 1980.
Yamamoto T., Fukuyama J., Hasegawa K., Sugiura M. Isolated corticotrophin deficiency in adults. Arch. Intern. Med. 152: 1705, 1992.
Bottazzo G.F., Pouplard A., Florin-Christensen A., Doniach D. Autoantibodies to prolactin secreting cells of human pituitary. Lancet ii: 97, 1975.
Scherbaum W.A., Schrell U., Glück M., Fahlbusch R., Pfeiffer E.F. Autoantibodies to pituitary corticotropin-producing cells: possible marker for unfavourable outcome after pituitary microsurgery for Cushing’s disease. Lancet i: 1394, 1987.
Mau M., Phillips T.M., Ratner R.E. Presence of anti-pituitary hormone antibodies in patients with empty sella syndrome and pituitary tumours. Clin. Endocrinol. (Oxf.) 38: 495, 1993.
Weetman A.P Autoimmune Endocrine Disease. Cambridge University Press, Cambridge, 1991, p. 260.
Sachson R., Rosen S.W., Cuatrecasas P., Roth J., Frantz A.G. Prolactin stimulation by thyrotropin-releasing hormone in a patient with isolated thyrotropin deficiency. N. Engl. J. Med. 287: 972, 1972.
Woolf P.D. Hypothyroidism and amenorrhea due to hypothalamic insufficiency. Am. J. Med. 63: 343, 1977.
Katakami H., Kato Y., Inada M., Imura H. Hypothalamic hypothyroidism due to isolated thyrotropin-releasing hormone (TRH) deficiency. J. Endocrinol. Invest. 7: 231, 1984.
Foresti V., Parisio E. Hypothyroidism due to TSH deficiency: report of one case and literature review. Min. Med. 76: 2323, 1985.
Baien A.H., Manning P.J. A case of isolated TSH deficiency presenting as infertility. Postgrad. Med. J. 70: 225, 1994.
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Peacey, S.R., Price, A., Giles, M.A. et al. Isolated TSH deficiency with a partially empty sella. J Endocrinol Invest 18, 729–733 (1995). https://doi.org/10.1007/BF03349796
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DOI: https://doi.org/10.1007/BF03349796