A Girl with Goiter and Inappropriate Thyroid-Stimulating Hormone Secretion

摘要: A 15-year-old white girl presented with neck tenderness. On examination, a nodule was palpated in the right thyroid lobe. The supple without abnormal lymphadenopathy. Eye findings related to Graves orbitopathy were absent. Weight, height, and blood pressure unremarkable, but heart rate high at 104–114 bpm. patient had history of attention deficit hyperactivity disorder taking atomoxetine fluoxetine. There no childhood irradiation or family cancer. Several maternal relatives have acquired dysfunction. Sonography showed 2-cm Fine-needle aspiration benign cytology, requested lobectomy for persistent Preoperative laboratory data revealed total thyroxine (T4)1 concentration 170 nmol/L \[reference interval (RI) 67–138 nmol/L\] (13.2 μg/dL, RI 5.2–10.7), triiodothyronine (T3) 3.2 (RI 1.3–2.4 nmol/L) (206 ng/dL, 86–153), thyroid-stimulating hormone (TSH) 0.5 mIU/L 0.3–5.0 mIU/L), binding ratio (1/T-uptake) 1.72 0.77–1.16) (Table 1⇓ ). Analyses conducted by chemiluminescent immunoassay on Roche Elecsys 2010 platform. Free T3 free T4 indices as calculated clinicians 5.5 292 nmol/L), respectively, and, context patient’s normal TSH concentration, suggested possibility inappropriate secretion due resistance TSH-secreting pituitary adenoma. serum measured direct dialysis RIA Mayo Medical Laboratories 16.8 pmol/L 10.3–25.8 pmol/L) (1.3 1–2 ng/dL). Although certain features, including her tachycardia (1)(2), consistent syndrome …