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

ABSTRACT

Background: Resistance to thyroid hormone (RTH) due to THRβ 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 THRβ 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 THRβ 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