Horm Metab Res 2015; 47(12): 889-894
DOI: 10.1055/s-0035-1545305
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Two Novel Mutations in the Thyroid Hormone Receptor β in Patients with Resistance to Thyroid Hormone (RTH β): Clinical, Biochemical, and Molecular Data

A. M. Esquiaveto-Aun
1   Department of Pediatrics, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, Brazil
2   Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, Brazil
3   Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, Brazil
,
D. E. Zantut-Wittmann
4   Division of Endocrinology, Department of Clinical Medicine, FCM, UNICAMP, Campinas, Brazil
,
R. J. Petroli
2   Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, Brazil
,
B.S. L. Nakano
4   Division of Endocrinology, Department of Clinical Medicine, FCM, UNICAMP, Campinas, Brazil
,
G. Guerra-Júnior
1   Department of Pediatrics, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, Brazil
3   Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, Brazil
,
S.H. V. de Lemos-Marini
1   Department of Pediatrics, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, Brazil
3   Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, Brazil
,
M. P. de Mello
2   Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, Brazil
› Author Affiliations
Further Information

Publication History

received 22 October 2014

accepted 29 January 2015

Publication Date:
04 March 2015 (online)

Abstract

The syndrome of resistance to thyroid hormone (RTH β) is an inherited disorder characterized by variable tissue hyposensitivity to 3,5,30-l-triiodothyronine (T3), with persistent elevation of free-circulating T3 (FT3) and free thyroxine (FT4) levels in association with nonsuppressed serum thyrotropin (TSH). Clinical presentation is variable and the molecular analysis of THRB gene provides a short cut diagnosis. Here, we describe 2 cases in which RTH β was suspected on the basis of laboratory findings. The diagnosis was confirmed by direct THRB sequencing that revealed 2 novel mutations: the heterozygous p.Ala317Ser in subject 1 and the heterozygous p.Arg438Pro in subject 2. Both mutations were shown to be deleterious by SIFT, PolyPhen, and Align GV-GD predictive methods.

 
  • References

  • 1 Refetoff S, Dumitrescu AM. Syndromes of reduced sensitivityto thyroid hormone: genetic defects in hormone receptors, cell transportes and deiodination. Best Pract Res Clin Endocrinol Metab 2007; 21: 277-305
  • 2 Weiss RE, Refetoff S. Resistance to thyroid hormone. Rev Endocr Metab Disord 2000; 1: 97-108
  • 3 Refetoff S, DeWind LT, DeGroot LJ. Familial syndrome combining deaf-mutism, stippled epiphyses, goiter and abnormally high PBI: Possible target organ refractoriness to thyroid hormone. J Clin Endocrinol Metab 1967; 27: 279-294
  • 4 Weinberger C, Thompson CC, Ong ES, Lebo R, Gruol DJ, Evans RM. The c-erb-A gene encodes a thyroid hormone receptor. Nature (London) 1986; 324: 641-646
  • 5 Usala SJ, Bale AE, Gesundheit Weinberger C, Lash RW, Wondisford FE, Mc Bride OW, Weintraub BD. Tight linkage between the syndrome of generalized thyroid hormone resistance and the human c-erbA beta gene. Mol Endocrinol 1988; 2: 1217-1220
  • 6 Slezak RA, Lukienczuk T, Nocynska A, Karpinski P, Lebioda A, Misiak B, Sasiadek MM. A novel p.E311K mutation of thyroid receptor beta gene in resistance to thyroid hormone syndrome, inherited in autosomal recessive trait. Horm Metab Res 2012; 44: 704-707
  • 7 Refetoff S, Bassett JH, Beck-Peccoz P, Bernal J, Brent G, Chatterjee K, De Groot LJ, Dumitrescu AM, Jameson JL, Kopp PA, Murata Y, Persani L, Samarut J, Weiss RE, Williams GR, Yen PM. Classification and proposed nomenclature for inherited defects of thyroid hormone action, cell transport, and metabolism. Thyroid 2014; 24: 407-409
  • 8 Refetoff S. Resistance to thyroid hormone: one of several defects causing reduced sensitivity to thyroid hormone. Nat Clin Pract Endocrinol Metab 2008; 4: 1
  • 9 Takeda K, Sakurai A, DeGroot LJ, Refetoff S. Recessive inheritance of thyroid hormone resistance caused by complete deletion of the protein-coding region of the thyroid hormone receptor-β gene. J Clin Endocrinol Metab 1992; 74: 49-55
  • 10 Usala SJ, Menke JB, Watson TL, Wondisford FE, Weintraub BD, Bérard J, Bradley WE, Ono S, Mueller OT, Bercu BB. A homozygous deletion in the c-erbA beta thyroid hormone receptor gene in a patient with generalized thyroid hormone resistance: isolation and characterization of the mutant receptor. Mol Endocrinol 1991; 5: 327-335
  • 11 Ferrara AM, Onigata K, Ercan O, Woodhead H, Weiss RE, Refetoff S. Homozygous thyroid hormone receptor β-gene mutations in resistance to thyroid hormone: three new cases and review of the literature. J Clin Endocrinol Metab 2012; 97: 1328-1336
  • 12 Sakurai A, Miyamoto T, Refetoff S, DeGroot LJ. Dominant negative transcriptional regulation by a mutant thyroid hormone receptor-b in a family with generalized thyroid hormone resistance. Mol Endocrinol 1990; 4: 1988-1994
  • 13 Jameson JL. Mechanisms by which thyroid hormone receptor mutations cause clinical syndromes of resistance to thyroid hormone. Thyroid 1994; 4: 485-492
  • 14 Weiss RE, Hayashi Y, Nagaya T, Petty KJ, Murata Y, Tunca H, Seo H, Refetoff S. Dominant inheritance of resistance to thyroid hormone not linked to defects in the thyroid hormone receptors α or β genes may be due to a defective co-factor. J Clin Endocrinol Metab 1996; 81: 4196-4203
  • 15 Weiss RE, Weinberg M, Refetoff S. Identical mutations in unrelated families with generalized resistance to thyroid hormone occur in cytosine–guanine-rich areas of the thyroid hormone receptor beta gene: analysis of 15 families. J Clin Invest 1993; 91: 2408-2415
  • 16 Beck-Peccoz P, Chatterjee VK. The variable clinical phenotype in thyroid hormone resistance syndrome. Thyroid 1994; 4: 225-232
  • 17 Dumitrescu AM, Refetoff S. The syndromes of reduced sensitivity to thyroid hormone. Biochimica et Biophysica Acta 2013; 1830: 3987-4003
  • 18 Işık E, Beck-Peccoz P, Campi I, Özön A, Alikaşifoğlu A, Gönç N, Kandemir N. Thyroid hormone resistance: a novel mutation in thyroid hormone receptor beta (THRB) gene – case report. Turk J Pediatr 2013; 55: 322-327
  • 19 Chiesa A, Olcese MC, Papendieck P, Martinez A, Vieites A, Bengolea S, Targovnik HM, Rivolta CM, Gruñeiro-Papendieck L. Variable clinical presentation and outcome in pediatric patients with resistance to thyroid hormone (RTH). Endocrine 2012; 41: 130-137
  • 20 Parrila R, Mixson AJ, McPherson JA, McClaskey JH, Weintraub BD. Characterization of seven novel mutations of the c-erbA beta gene in unrelated kindreds with generalized thyroid hormone resistance. Evidence for two “hot spot” regions of the ligand binding domain. J Clin Invest 1991; 88: 2123-2130
  • 21 Seto D, Weintraub BD. Rapid molecular diagnosis of mutations associated with generalized thyroid hormone resistance by PCR-coupled automated direct sequencing of genomic DNA: detection of two novel mutations. Hum Mutat 1996; 8: 247-257
  • 22 Huber BR, Sandler B, West BL, Cunha Lima ST, Nguyen HT, Apriletti JW, Baxter JD, Fletterick RJ. Two resistance to thyroid hormone mutants with impaired hormone binding. Mol Endocrinol 2003; 17: 643-652
  • 23 Hayashi Y, Weiss RE, Sarne DH, Yen PM, Sunthornthepvarakul T, Marcocci C, Chin WW, Refetoff S. Do clinical manifestations of resistance to thyroid hormone correlate with the functional alteration of the corresponding mutant thyroid hormone-beta receptors?. J Clin Endocrinol Metab 1995; 80: 3246-3256
  • 24 Magalhães PK, Rodrigues Dare GL, Rodrigues Dos Santos S, Nogueira CR, de Castro M, Zanini Maciel LM. Clinical features and genetic analysis of four Brazilian kindreds with resistance to thyroid hormone. Clin Endocrinol 2007; 67: 748-753
  • 25 Adams M, Matthews C, Collingwood TN, Tone Y, Beck-Peccoz P, Chatterjee KK. Genetic analysis of 29 kindreds with generalized and pituitary resistance to thyroid hormone. Identification of thirteen novel mutations in the thyroid hormone receptor beta gene. J Clin Invest 1994; 94: 506-515
  • 26 Boothroyd CV, Teh BT, Hayward NK, Hickman PE, Ward GJ, Cameron DP. Single base mutation in the hormone binding domain of the thyroid hormone receptor beta gene in generalised thyroid hormone resistance demonstrated by single stranded conformation polymorphism analysis. Biochem Biophys Res Commun 1991; 178: 606-612