Consumptive hypothyroidism: a case report and review of the literature

Jassam, Nuthar; Visser, Theo J.; Brisco, T.; Bathia, Deepan; McClean, Patricia; Barth, Julian H.

doi:10.1258/acb.2010.010170

Cited by 25 publications

(25 citation statements)

References 14 publications

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“…However, he required high doses of T4 to maintain euthyroid status during the early phase of the disease. This high dose requirement has been shown in previous cases, and some patients require combined T4 and T3 replacement or intravenous T3 replacement (10 ). However, the thyroid hormone requirement decreases with the involution of the tumor.…”

Section: Consumptive Hypothyroidismsupporting

confidence: 54%

A Baby Boy with Hypothyroidism and Hemangioendothelioma

et al. 2014

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A full-term baby boy underwent an ultrasound scan of the abdomen at 6 weeks of age for the follow-up of an antenatal diagnosis of left-sided hydronephrosis. Although there was no hydronephrosis, the abdominal ultrasound revealed an enlarged liver with multiple hypoechoic lesions measuring up to 25 mm in diameter. He was admitted to the hospital for further evaluation of the hepatic lesions.Examination revealed multiple small external hemangiomas on the scalp and both wrists and axilla. The infant's abdomen was distended with hepatomegaly 6 -7 cm below the costal margin. There was no evidence of cardiac failure, an observation that was confirmed by a cardiology consult. His electrolytes, creatinine, urine catecholamine metabolites, ␣-fetoprotein, and liver enzymes were all within reference intervals, except for an increased ␥-glutamyl transferase of 257 IU/L (reference interval, 7-64 IU/L). Thyroid function tests (TFT) 7 revealed an increased thyroid-stimulating hormone (TSH) concentration of 37.7 mU/L (age-specific reference interval, 0.30 -5.00 mU/L), free thyroxine (fT4) within the reference interval at 17.9 pmol/L (agespecific reference interval, 12.0 -30.0 pmol/L), and low free triiodotyronine (fT3) of 3.3 pmol/L (age-specific reference interval, 3.8 -6.0 pmol/L) (Beckman DxI, Beckman Coulter). Thyroid peroxidase and thyroglobulin antibodies were negative. The newborn TSH screening test results were within reference intervals. MRI scan of the abdomen showed multiple liver lesions consistent with hemangioendothelioma. DISCUSSION DISCREPANCY IN THYROID FUNCTION TESTS AND FURTHER INVESTIGATIONSAnalytical interference in TSH or fT4 immunoassay, congenital hypothyroidism secondary to dyshormonogenesis, and consumptive hypothyroidism due to hemangioendothelioma are the possible causes for discrepant TSH and fT4 results in this patient.We excluded possible TFT assay interferences by reanalyzing the TFT after using heterophile antibody blocking tubes (Scantibodies Laboratories) and by rechecking TFT results with different analyzers (Siemens Centaur and Roche E602).A Technetium-99m thyroid uptake scan showed normal thyroid location, size, and uptake. The reverse T3 (rT3) concentration was 20.95 nmol/L (adult reference interval, 0.17-0.45 nmol/L). The rT3 was measured using an RIA (RADIM). The rT3 concentrations are highest immediately after birth in umbilical cord blood (0.3-5.51 nmol/L); however, these concentrations gradually decrease during infancy and childhood (1 ). PROBABLE DIAGNOSIS AND FOLLOW-UPA diagnosis of consumptive hypothyroidism associated with hepatic hemangioendothelioma (HHE) was considered the most probable explanation of abnormal thyroid function in this baby.L-T4 replacement was commenced at 25 g/day (4.2 g/kg per day), which is a standard dose (range 2.5-5 g/kg per day). This dose was increased to 100 g/day (16 g/kg per day) over the next 4 weeks. The patient's hemangioendothelioma was treated with prednisolone and propranolol.

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Section: Consumptive Hypothyroidismsupporting

confidence: 54%

A Baby Boy with Hypothyroidism and Hemangioendothelioma

et al. 2014

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“…Congenital thyroid dysfunction may also arise in the context of other complex disorders, such as Alagille syndrome type 1 due to JAG1 mutations (ALGS1) [35] and hepatic or parotid massive hemangiomas, which may produce the thyroid hormone–inactivating enzyme type 3 iodothyronine deiodinase [36, 37]. …”

Section: Mild Hypothyroidism In Neonatesmentioning

confidence: 99%

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

Vigone

Capalbo

Weber

et al. 2018

Journal of the Endocrine Society

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Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.

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“…Most studies on this type of consumptive hypothyroidism report the use of levothyroxine or levothyroxine plus liothyronine for treatment [1][2][3][4][5][6][7][8][9][10][11][12]14]; while 1 study reported the use of liothyronine plus prednisolone [13]. However, there is no report of using liothyronine plus propranolol for the treatment of consumptive hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%