Our data suggest that alterations in codons 436-453 in helix 11 result in significantly diminished association with nuclear receptor corepressor but not SMRT. This novel mutTRbeta demonstrates nuclear corepressor specificity that results in severe predominantly pituitary RTH due to impaired release of SMRT.
There are few indications for ordering a RAIU or a thyroid scan in a primary care setting. In suspected hyperthyroidism, a sensitive thyrotropin assay should be the initial test ordered. If the thyrotropin level is low or suppressed, and the diagnosis of thyroiditis vs Graves' hyperthyroidism is not clear, a RAIU test is appropriate. In the case of a euthyroid nodular goiter, fine-needle aspiration is the most accurate initial test to evaluate for malignancy. The primary indication for a scan in the case of a euthyroid nodular goiter is a low or suppressed thyrotropin level, because malignancy is rare in a hot nodule. If thyroid cancer or congenital hypothyroidism is encountered, referral to an endocrinologist is probably the most expedient and cost-effective way to proceed.
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