Euthyroid Hyperthyrotropinemia Secondary to Hyperestrogenemia in a Male With Congenital Adrenal Hyperplasia

Benvenga, Salvatore; Smedile, G; Giudice, Francesco Lo; Alesci, Salvatore; Amato, Angélica Amorim; Trimarchi, Francesco

doi:10.1055/s-2007-978644

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…In both patients, the highest TSH levels coincided with the highest levels of both estradiol (>300 pg/mL) and PRL, a well-known estrogen-upregulated hormone. Such estrogen dependency of serum TSH in the two women agrees with data of the literature ( 1 , 3 – 8 ). These data are (i) the progressively increasing serum levels of TSH during gestation; (ii) the greater serum TSH levels in women with polycystic ovary syndrome or in women taking estroprogestins compared to control women, and in reproductive age women compared to men; (iii) the increased daily requirement of levothyroxine during endogenous or exogenous hyperestrogenism.…”

Section: Discussionsupporting

confidence: 91%

Serum Thyrotropin and Phase of the Menstrual Cycle

et al. 2017

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About one-fifth of patients treated with levothyroxine have serum thyrotropin (TSH) above target concentrations but, in approximately 15% of them, the cause of this TSH insufficient normalization remains unknown. We report the cases of two regularly menstruating women with known thyroid disease who had TSH levels consistently >3 mU/L (and sometimes above target levels) during mid-cycle, but consistently lower serum levels during the follicular and luteal phases of menstrual cycle. A major TSH release by the thyrotrophs in response to high circulating levels of estradiol (E2) at mid-cycle may increase levels of TSH compared to other phases of the cycle. The increased TSH can be misinterpreted as refractory hypothyroidism if the woman is under L-T4 replacement therapy or as subclinical hypothyroidism if the woman is not. Our findings might have important implications for diagnosis and management of thyroid disease, suggesting to request serum TSH measurements outside of the periovulatory days.

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Section: Discussionsupporting

confidence: 91%

Serum Thyrotropin and Phase of the Menstrual Cycle

et al. 2017

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“…Serum E2 correlated directly with PRL and TSH [27] . Upon dexamethasone therapy, steroid hormones, PRL and TSH returned progressively normal [27] .…”

Section: Discussionmentioning

confidence: 87%

“…Particularly, in a well-characterized, disease-free population, median (2.5th-95th percentile) serum TSH levels of females aged 20–39 years were 2.49 mU/L (0.75–7.90), >2.23 mU/L (0.70–6.50) of age-matched males [26] . Finally, a 10-year-old boy with congenital adrenal hyperplasia and associated hyperplastic testicular adrenal rests had high serum concentrations of 17-OHPg, E2, testosterone, basal and TRH-stimulated TSH and PRL [27] . Serum E2 correlated directly with PRL and TSH [27] .…”

Section: Discussionmentioning

confidence: 98%

“…Finally, a 10-year-old boy with congenital adrenal hyperplasia and associated hyperplastic testicular adrenal rests had high serum concentrations of 17-OHPg, E2, testosterone, basal and TRH-stimulated TSH and PRL [27] . Serum E2 correlated directly with PRL and TSH [27] . Upon dexamethasone therapy, steroid hormones, PRL and TSH returned progressively normal [27] .…”

Section: Discussionmentioning

confidence: 98%

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Circulating thyrotropin is upregulated by estradiol

Benvenga¹,

Bari²,

Granese³

et al. 2018

Journal of Clinical & Translational Endocrinology

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After encountering two women with serum thyrotropin (TSH) levels greater in periovulatory phase than in other days of the menstrual cycle, we hypothesized that TSH levels could be sensitive to changes in circulating estrogens in women.The objective of this study was to evaluate whether serum TSH increases after an induced acute increase of serum estradiol, and compare serum TSH increase with that of prolactin (PRL) which is a classic estradiol-upregulated pituitary hormone.In this retrospective study, we resorted to stored frozen sera from 55 women who had undergone the GnRH agonist (buserelin)-acute stimulation test of ovarian steroidogenesis. This test, that is preceded by dexamethasone administration to suppress adrenal steroidogenesis, had been performed to show an increased buserelin-stimulated response of 17-hydroxyprogesterone, a response that is frequent in polycystic ovary syndrome. Fifty-five women had enough serum volume at pertinent times (first observation early in the follicular phase and all times of the test) to permit assay of serum estradiol, TSH and PRL.Before dexamethasone administration, estradiol averaged 26.4 ± 15.5 pg/ml (reference range 23–139, follicular phase), TSH 1.78 ± 0.86 mU/L (reference range 0.3–4.2) and PRL 409.4 ± 356 mU/L (reference range 70.8–556) (mean ± SD).Serum estradiol, TSH and PRL averaged 47.2 ± 27 pg/ml, 0.77 ± 0.48 mU/L and 246.4 ± 206.8 mU/L just prior to the buserelin injection, but they peaked at 253.4 ± 113.5 pg/ml (nv 83–495, midcycle), 3.30 ± 1.65 mU/L and 540.3 ± 695.2 mU/L after injection. The responses to buserelin of estradiol, TSH and PRL were of wide magnitude. There was a significant correlation between TSH peak and serum estradiol peak, betweeen AUC0-24 h-TSH and AUC0-24 h-estradiol, or between PRL peak and estradiol peak and AUC0-24 h -PRL and AUC0-24 h-estradiol in only a subgroup of women.Therefore, women with estradiol-dependent increase in serum TSH do exist. Reference bands of serum TSH dependent on the phases of the menstrual cycle should be available.

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Physiological and Pathological Aspects of Full Breast Ultrasonography in Men and Children

Colan-Georges

2016

Atlas of Full Breast Ultrasonography

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Euthyroid Hyperthyrotropinemia Secondary to Hyperestrogenemia in a Male With Congenital Adrenal Hyperplasia

Cited by 4 publications

References 7 publications

Serum Thyrotropin and Phase of the Menstrual Cycle

Serum Thyrotropin and Phase of the Menstrual Cycle

Circulating thyrotropin is upregulated by estradiol

Physiological and Pathological Aspects of Full Breast Ultrasonography in Men and Children

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