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Different causes of Reduced Sensitivity to Thyroid Hormone: Diagnosis and Clinical management
Author(s) -
Visser W. Edward,
Mullem Alies A. A.,
Visser Theo J.,
Peeters Robin P.
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12281
Subject(s) - endocrinology , medicine , thyroid , hormone , phenotype , biology , genetics , gene
Summary Normal thyroid hormone ( TH ) metabolism and action require adequate cellular TH signalling. This entails proper function of TH transporters in the plasma membrane, intracellular deiodination of TH and action of the bioactive hormone T3 at its nuclear receptors ( TR s). The present review summarizes the discoveries of different syndromes with reduced sensitivity at the cellular level. Mutations in the TH transporter MCT 8 cause psychomotor retardation and abnormal thyroid parameters. Mutations in the SBP 2 protein, which is required for normal deiodination, give rise to a multisystem disorder including abnormal thyroid function tests. Mutations in TR β1 are a well‐known cause of resistance to TH with mostly a mild phenotype, while only recently, patients with mutations in TR α1 were identified. The latter patients have slightly abnormal TH levels, growth retardation and cognitive defects. This review will describe the mechanisms of disease, clinical phenotype, diagnostic testing and suggestions for treatment strategies for each of these syndromes.