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Endocrine Reviews, doi:10.1210/edrv-14-3-348
Endocrine Reviews 14 (3): 348-399
Copyright © 1993 by The Endocrine Society
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The Syndromes of Resistance to Thyroid Hormone*

SAMUEL REFETOFF, ROY E. WEISS and STEPHEN J. USALA

Department of Medicine, The University of Chicago Chicago, Illinois 60637
Department of Pediatrics, The University of Chicago Chicago, Illinois 60637
Department of the J.P. Kennedy, Jr. Mental Retardation Research Center, The University of Chicago Chicago, Illinois 60637
Department of Medicine, East Carolina University, School of Medicine Greenville, North Carolina 27858

Correspondence: Address requests for reprints to: Samuel Refetoff, M.D., Thyroid Study Unit-MC3090, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637.

Abstract

I. Introduction: THE syndromes of resistance to thyroid hormone are characterized by reduced clinical and biochemical manifestations of thyroid hormone action relative to the circulating hormone levels. In practice, most patients are identified by the persistent elevation of serum levels of T4 and T3 with "inappropriately" nonsuppressed TSH, in the absence of intercurrent acute illness, drugs, or alterations of thyroid hormone binding to serum proteins. More importantly, administration of supraphysiological doses of thyroid hormone fail to produce the expected suppressive effect on the secretion of pituitary TSH and/or to induce the expected metabolic responses in the peripheral tissues. Since the publication of the index cases in 1967 (1), 347 subjects have been reported who exhibit the characteristics of the syndrome (Refs. 1–129 and our personal communications and observations). In this review, we summarize all cases known to us, present their common features as well as unusual manifestations, and attempt to analyze and relate both clinical and laboratory findings. Special emphasis is given to recent advances in diagnostic procedures and in genetic studies which, in addition to identifying the etiology of the resistance, have contributed to the understanding of the molecular mechanisms of thyroid hormone action. The ultimate goal is to provide more accurate means of establishing the diagnosis, earlier recognition of the disorder, and more effective approaches to therapy.

Footnotes

A glossary of abbreviations appears on page 391.

* Work from the authors' laboratories presented herein and the preparation of this review were supported by grants from the National Institutes of Health DK-15070 and DK-42807 and USPHS Grant RR-00055.




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J. Clin. Endocrinol. Metab.Home page
J. Anselmo, T. Kay, K. Dennis, R. Szmulewitz, S. Refetoff, and R. E. Weiss
Resistance to Thyroid Hormone Does Not Abrogate the Transient Thyrotoxicosis Associated with Gestation: Report of a Case
J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4273 - 4275.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
S. Ando, N. J. Sarlis, J. Krishnan, X. Feng, S. Refetoff, M. Q. Zhang, E. H. Oldfield, and P. M. Yen
Aberrant Alternative Splicing of Thyroid Hormone Receptor in a TSH-Secreting Pituitary Tumor Is A Mechanism for Hormone Resistance
Mol. Endocrinol., September 1, 2001; 15(9): 1529 - 1538.
[Abstract] [Full Text] [PDF]


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Physiol. Rev.Home page
P. M. Yen
Physiological and Molecular Basis of Thyroid Hormone Action
Physiol Rev, July 1, 2001; 81(3): 1097 - 1142.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
K. Fujiwara, H. Adachi, T. Nishio, M. Unno, T. Tokui, M. Okabe, T. Onogawa, T. Suzuki, N. Asano, M. Tanemoto, et al.
Identification of Thyroid Hormone Transporters in Humans: Different Molecules Are Involved in a Tissue-Specific Manner
Endocrinology, May 1, 2001; 142(5): 2005 - 2012.
[Abstract] [Full Text]


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Mol. Endocrinol.Home page
L. L. Amma, A. Campos-Barros, Z. Wang, B. Vennström, and D. Forrest
Distinct Tissue-Specific Roles for Thyroid Hormone Receptors {beta} and {{alpha}}1 in Regulation of Type 1 Deiodinase Expression
Mol. Endocrinol., March 1, 2001; 15(3): 467 - 475.
[Abstract] [Full Text]


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JAMAHome page
J. D. Wilson
Prospects for Research for Disorders of the Endocrine System
JAMA, February 7, 2001; 285(5): 624 - 627.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
K.-h. Lin and Y.-h. Wu shen-liang chen
Impaired Interaction of Mutant Thyroid Hormone Receptors Associated with Human Hepatocellular Carcinoma with Transcriptional Coregulators
Endocrinology, February 1, 2001; 142(2): 653 - 662.
[Abstract] [Full Text] [PDF]


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Arch Gen PsychiatryHome page
D. N. Orth, R. C. Shelton, W. E. Nicholson, P. Beck-Peccoz, A. J. Tomarken, L. Persani, and P. T. Loosen
Serum Thyrotropin Concentrations and Bioactivity During Sleep Deprivation in Depression
Arch Gen Psychiatry, January 1, 2001; 58(1): 77 - 83.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
S. Reutrakul, P. M. Sadow, S. Pannain, J. Pohlenz, G. A. Carvalho, P. E. Macchia, R. E. Weiss, and S. Refetoff
Search for Abnormalities of Nuclear Corepressors, Coactivators, and a Coregulator in Families with Resistance to Thyroid Hormone without Mutations in Thyroid Hormone Receptor {beta} or {alpha} Genes
J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3609 - 3617.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
E. A. Jannini, A. Crescenzi, N. Rucci, E. Screponi, E. Carosa, A. De Matteis, E. Macchia, G. d’Amati, and M. D’Armiento
Ontogenetic Pattern of Thyroid Hormone Receptor Expression in the Human Testis
J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3453 - 3457.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
S. Pannain, M. Feldman, U. Eiholzer, R. E. Weiss, N. H. Scherberg, and S. Refetoff
Familial Dysalbuminemic Hyperthyroxinemia in a Swiss Family Caused by a Mutant Albumin (R218P) Shows an Apparent Discrepancy between Serum Concentration and Affinity for Thyroxine
J. Clin. Endocrinol. Metab., August 1, 2000; 85(8): 2786 - 2792.
[Abstract] [Full Text]


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Mol. Endocrinol.Home page
X. Feng, Y. Jiang, P. Meltzer, and P. M. Yen
Thyroid Hormone Regulation of Hepatic Genes in Vivo Detected by Complementary DNA Microarray
Mol. Endocrinol., July 1, 2000; 14(7): 947 - 955.
[Abstract] [Full Text]


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Mol. Endocrinol.Home page
R. N. Cohen, A. Putney, F. E. Wondisford, and A. N. Hollenberg
The Nuclear Corepressors Recognize Distinct Nuclear Receptor Complexes
Mol. Endocrinol., June 1, 2000; 14(6): 900 - 914.
[Abstract] [Full Text]


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Mol. Endocrinol.Home page
M. Anafi, Y.-F. Yang, N. A. Barlev, M. V. Govindan, S. L. Berger, T. R. Butt, and P. G. Walfish
GCN5 and ADA Adaptor Proteins Regulate Triiodothyronine/GRIP1 and SRC-1 Coactivator-Dependent Gene Activation by the Human Thyroid Hormone Receptor
Mol. Endocrinol., May 1, 2000; 14(5): 718 - 732.
[Abstract] [Full Text]


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Circ. Res.Home page
C. Pazos-Moura, E. D. Abel, M.-E. Boers, E. Moura, T. G. Hampton, J. Wang, J. P. Morgan, and F. E. Wondisford
Cardiac Dysfunction Caused by Myocardium-Specific Expression of a Mutant Thyroid Hormone Receptor
Circ. Res., March 31, 2000; 86(6): 700 - 706.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
New
Resistance to Several Steroids in Two Sisters
J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4454 - 4464.
[Abstract] [Full Text]


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EndocrinologyHome page
M. Gurnell, O. Rajanayagam, M. Agostini, R. J. D. Clifton-Bligh, T. Wang, P. M. J. Zelissen, F. van der Horst, A. v. d. Wiel, E. Macchia, A. Pinchera, et al.
Three Novel Mutations at Serine 314 in the Thyroid Hormone {beta} Receptor Differentially Impair Ligand Binding in the Syndrome of Resistance to Thyroid Hormone
Endocrinology, December 1, 1999; 140(12): 5901 - 5906.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
J. Pohlenz, R. E. Weiss, P. E. Macchia, S. Pannain, I. T. Lau, H. Ho, and S. Refetoff
Five New Families with Resistance to Thyroid Hormone not Caused by Mutations in the Thyroid Hormone Receptor {beta} Gene
J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 3919 - 3928.
[Abstract] [Full Text]


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EndocrinologyHome page
G. Barrera-Hernandez, K. S. Park, A. Dace, Q. Zhan, and S.-y. Cheng
Thyroid Hormone-Induced Cell Proliferation in GC Cells Is Mediated by Changes in G1 Cyclin/Cyclin-Dependent Kinase Levels and Activity
Endocrinology, November 1, 1999; 140(11): 5267 - 5274.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
J. D. Safer, M. G. O’Connor, S. D. Colan, S. Srinivasan, S. R. Tollin, and F. E. Wondisford
The Thyroid Hormone Receptor-{beta} Gene Mutation R383H Is Associated with Isolated Central Resistance to Thyroid Hormone
J. Clin. Endocrinol. Metab., September 1, 1999; 84(9): 3099 - 3109.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
T. Abe, M. Kakyo, T. Tokui, R. Nakagomi, T. Nishio, D. Nakai, H. Nomura, M. Unno, M. Suzuki, T. Naitoh, et al.
Identification of a Novel Gene Family Encoding Human Liver-specific Organic Anion Transporter LST-1
J. Biol. Chem., June 11, 1999; 274(24): 17159 - 17163.
[Abstract] [Full Text] [PDF]


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Genes Dev.Home page
S. Göthe, Z. Wang, L. Ng, J. M. Kindblom, A. C. Barros, C. Ohlsson, B. Vennström, and D. Forrest
Mice devoid of all known thyroid hormone receptors are viable but exhibit disorders of the pituitary-thyroid axis, growth, and bone maturation
Genes & Dev., May 15, 1999; 13(10): 1329 - 1341.
[Abstract] [Full Text]


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Endocr. Rev.Home page
P. J. Malloy, J. W. Pike, and D. Feldman
The Vitamin D Receptor and the Syndrome of Hereditary 1,25-Dihydroxyvitamin D-Resistant Rickets
Endocr. Rev., April 1, 1999; 20(2): 156 - 188.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
M. Derwahl, M. Broecker, and Z. Kraiem
Thyrotropin May Not Be the Dominant Growth Factor in Benign and Malignant Thyroid Tumors
J. Clin. Endocrinol. Metab., March 1, 1999; 84(3): 829 - 834.
[Full Text]


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J. Clin. Endocrinol. Metab.Home page
R. E. Weiss and S. Refetoff
Editorial: Treatment of Resistance to Thyroid Hormone--Primum Non Nocere
J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 401 - 404.
[Full Text]


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J. Clin. Endocrinol. Metab.Home page
F. Brucker-Davis, E. H. Oldfield, M. C. Skarulis, J. L. Doppman, and B. D. Weintraub
Thyrotropin-Secreting Pituitary Tumors: Diagnostic Criteria, Thyroid Hormone Sensitivity, and Treatment Outcome in 25 Patients Followed at the National Institutes of Health
J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 476 - 486.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
M. J. Reginato, S. T. Bailey, S. L. Krakow, C. Minami, S. Ishii, H. Tanaka, and M. A. Lazar
A Potent Antidiabetic Thiazolidinedione with Unique Peroxisome Proliferator-activated Receptor gamma -activating Properties
J. Biol. Chem., December 4, 1998; 273(49): 32679 - 32684.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
T. Tagami, W.-X. Gu, P. T. Peairs, B. L. West, and J. L. Jameson
A Novel Natural Mutation in the Thyroid Hormone Receptor Defines a Dual Functional Domain That Exchanges Nuclear Receptor Corepressors and Coactivators
Mol. Endocrinol., December 1, 1998; 12(12): 1888 - 1902.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
J. D. Safer, R. N. Cohen, A. N. Hollenberg, and F. E. Wondisford
Defective Release of Corepressor by Hinge Mutants of the Thyroid Hormone Receptor Found in Patients with Resistance to Thyroid Hormone
J. Biol. Chem., November 13, 1998; 273(46): 30175 - 30182.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
Y. Liu, A. Takeshita, S. Misiti, W. W. Chin, and P. M. Yen
Lack of Coactivator Interaction Can Be a Mechanism for Dominant Negative Activity by Mutant Thyroid Hormone Receptors
Endocrinology, October 1, 1998; 139(10): 4197 - 4204.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
M. Raval-Pandya, L. P. Freedman, H. Li, and S. Christakos
Thyroid Hormone Receptor Does Not Heterodimerize with the Vitamin D Receptor but Represses Vitamin D Receptor-Mediated Transactivation
Mol. Endocrinol., September 1, 1998; 12(9): 1367 - 1379.
[Abstract] [Full Text]


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Learn. Mem.Home page
M. P. McDonald, R. Wong, G. Goldstein, B. Weintraub, S.-y. Cheng, and J. N. Crawley
Hyperactivity and Learning Deficits in Transgenic Mice Bearing a Human Mutant Thyroid Hormone beta 1 Receptor Gene
Learn. Mem., September 1, 1998; 5(4): 289 - 301.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
T. Abe, M. Kakyo, H. Sakagami, T. Tokui, T. Nishio, M. Tanemoto, H. Nomura, S. C. Hebert, S. Matsuno, H. Kondo, et al.
Molecular Characterization and Tissue Distribution of a New Organic Anion Transporter Subtype (oatp3) That Transports Thyroid Hormones and Taurocholate and Comparison with oatp2
J. Biol. Chem., August 28, 1998; 273(35): 22395 - 22401.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
L. Persani, S. Borgato, R. Romoli, C. Asteria, A. Pizzocaro, and P. Beck-Peccoz
Changes in the Degree of Sialylation of Carbohydrate Chains Modify the Biological Properties of Circulating Thyrotropin Isoforms in Various Physiological and Pathological States
J. Clin. Endocrinol. Metab., July 1, 1998; 83(7): 2486 - 2492.
[Abstract] [Full Text]


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Mol. Endocrinol.Home page
R. J. Clifton-Bligh, F. de Zegher, R. L. Wagner, T. N. Collingwood, I. Francois, M. Van Helvoirt, R. J. Fletterick, and V. K. K. Chatterjee
A Novel TR{beta} Mutation (R383H) in Resistance to Thyroid Hormone Syndrome Predominantly Impairs Corepressor Release and Negative Transcriptional Regulation
Mol. Endocrinol., May 1, 1998; 12(5): 609 - 621.
[Abstract] [Full Text]


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EndocrinologyHome page
T. Tagami and J. L. Jameson
Nuclear Corepressors Enhance the Dominant Negative Activity of Mutant Receptors That Cause Resistance to Thyroid Hormone
Endocrinology, February 1, 1998; 139(2): 640 - 650.
[Abstract] [Full Text] [PDF]


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DevelopmentHome page
M Knipper, C Bandtlow, L Gestwa, I Kopschall, K Rohbock, B Wiechers, H. Zenner, and U Zimmermann
Thyroid hormone affects Schwann cell and oligodendrocyte gene expression at the glial transition zone of the VIIIth nerve prior to cochlea function
Development, January 9, 1998; 125(18): 3709 - 3718.
[Abstract] [PDF]


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Mol. Endocrinol.Home page
Y. Liu, A. Takeshita, T. Nagaya, A. Baniahmad, W. W. Chin, and P. M. Yen
An Inhibitory Region of the DNA-Binding Domain of Thyroid Hormone Receptor Blocks Hormone-Dependent Transactivation
Mol. Endocrinol., January 1, 1998; 12(1): 34 - 44.
[Abstract] [Full Text]


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Toxicol Ind HealthHome page
P. Hauser, J. M. McMillin, and V. S. Bhatara
Resistance To Thyroid Hormone: Implications for Neurodevelopmental Research On the Effects of Thyroid Hormone Disruptors
Toxicology and Industrial Health, January 1, 1998; 14(1-2): 85 - 101.
[Abstract] [PDF]


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Toxicol Ind HealthHome page
E. S. Sher, Xiao Ming Xu, P. M. Adams, C. M. Craft, and S. A. Stein
The Effects of Thyroid Hormone Level and Action in Developing Brain: Are These Targets for the Actions of Polychlorinated Biphenyls and Dioxins?
Toxicology and Industrial Health, January 1, 1998; 14(1-2): 121 - 158.
[Abstract] [PDF]




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