ALTERNATE DAY PREDNISOLONE IS SAFE AND EFFECTIVE IN RELIEVING THE THYROTOXIC SYMPTOMS OF A CHILD WITH RESISTANCE TO THYROID HORMONE
Abdulmoein E. AL-Agha*, Ihab Abdulhameed and Abdelhadi M. Habeb
Background: Resistance to thyroid hormone (RTH) due to THRÎ² gene mutations is characterized by high fT4 and fT3 with unsuppressed TSH. The management of symptomatic children with this condition is a challenge. Glucocorticoids can suppress TSH secretion; however their use in RTH has not been explored. Aim: to report the clinical and hormonal response to alternate day prednisolone in RTH child with thyrotoxic symptoms. Methods: The child had regular clinical and biochemical assessment. Direct sequencing of the THRÎ² gene was conducted in the family. Results: The boy presented at 19 months with tachycardia, sweating, hyperactivity and delayed cognitive function. He had raised fT4, fT3 and TSH with normal MRI pituitary. Sequencing of the THRÎ² gene identified heterozygous mutation (A317T) in the child and his father. Propranolol was ineffective and carbimazole raised the TSH without clinical improvement. Alternate day prednisolone + atenolol relieved the symptoms and maintained TSH in the lower limit of normal. During the 29 months treatment the child maintained normal growth without steroids side effects. Conclusions: Our experience indicates that, alternate day prednisolone is safe and effective in relieving the thyrotoxic symptoms of RTH. This regimen would be an option for some children with RTH.
Keywords: Thyroid hormone resistance, Corticosteroids, TR beta receptor, children Established facts: ? The management of resistance to thyroid hormone (RTH) is a challenge and different agents have been used to suppress the TSH with variable success ? Steroids can
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