• Clinical and Experimental Pediatrics
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• 제48권3호
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• pp.337-341
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• 2005

선천성 갑상선 항진증은 드문 질환으로 모체로부터 TSH에 대한 자가항체가 태반을 통해 태아에게 전달되어 생기며 일시적인 경우가 많다. 선천성 갑상선 항진증이 지속되지만 자가면역질환의 검사 소견을 보이지 않을 때에는 TSHR의 돌연변이에 의한 갑상선 항진증을 고려해야 한다. 저자들은 TSHR의 돌연변이에 의한 갑상선 항진증 증례를 2례 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Annals of Pediatric Endocrinology and Metabolism
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• 제23권4호
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• pp.235-239
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• 2018

Most cases of congenital hyperthyroidism are autoimmune forms caused by maternal thyroid stimulating antibodies. Nonautoimmune forms of congenital hyperthyroidism caused by activating mutations of the thyrotropin receptor (TSHR) gene are rare. A woman gave birth to a boy during an emergency cesarean section at 33 weeks of gestation due to fetal tachycardia. On the 24th day of life, thyroid function tests were performed due to persistent tachycardia, and hyperthyroidism was confirmed. Auto-antibodies to TSHR, thyroid peroxidase, and thyroglobulin were not found. The patient was treated with propylthiouracil and propranolol, but hyperthyroidism was not well controlled. At 3 months of age, the patient had craniosynostosis and hydrocephalus, and underwent a ventriculoperitoneal shunt operation. Direct sequencing of the TSHR gene showed a heterozygous mutation of c.1899C>A (p.Asp633Glu) in exon 10. No mutations were discovered in any of the parents in a familial genetic study. We have reported a case of sporadic nonautoimmune congenital hyperthyroidism, by a missense mutation of the TSHR gene, for the first time in South Korea.

• Clinical and Experimental Pediatrics
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• 제50권6호
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• pp.576-579
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• 2007

갑상선 호르몬 저항성 증후군은 갑상선 호르몬에 대한 조직의 반응이 감소되어 나타나는 드문 유전 질환이다. 대부분은 갑상선 호르몬 수용체 (TR) 유전자의 돌연변이로 인한 갑상선 호르몬 수용체의 결함에 의한다. TR 유전자의 변이는 일반적으로 이형접합성이며 상염색체 우성 유전 양상을 보인다. 혈청 갑상선 호르몬 수치가 증가되어 있음에도 불구하고 혈청 갑상선 자극호르몬 수치가 억제되지 않으며, 임상 양상은 다양하다. 본 증례는 경미한 갑상선종, 총 및 유리 $T_4$, $T_3$의 증가, 정상 범위의 TSH 소견을 보이는 4세 여아로서 TR 유전자 분석에서 과오돌연변이(H435Y)를 확인하였다. 부모에서는 돌연변이가 관찰되지 않았으며, 갑상선 기능도 정상이었다. 특별한 투약 없이 추적 관찰 중에 갑상선종의 증가나 다른 증상의 악화는 없는 상태이다.

• The Korean Journal of Physiology and Pharmacology
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• 제2권1호
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• pp.101-108
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• 1998

We investigated the effect of ${\alpha}-subunit$ of the stimulatory GTP-binding protein ($G{\alpha}_s$) gene mutation on the expression of the thyrotropin-releasing hormone (TRH) receptor (TRH-R) gene in GH3 cells and in growth hormone (GH)-secreting adenomas of acromegalic patients. In the presence of cyclohexicmide, forskolin and isobutylmethylxanthine, cholera toxin, and GH-releasing hormone (GHRH) decreased rat TRH-R (rTRH-R) gene expression by about 39%, 43.7%, and 46.7%, respectively. Transient expression of a vector expressing mutant-type $G{\alpha}_s$ decreased the rTRH-R gene expression by about 50% at 24 h of transfection, whereas a wild-type $G{\alpha}_s$ expression vector did not. The transcript of human TRH-R (hTRH-R) gene was detected in 6 of 8 (75%) tumors. Three of them (50%) showed the paradoxical GH response to TRH and the other three patients did not show the response. The relative expression of hTRH-R mRNA in the tumors from patients with the paradoxical response of GH to TRH did not differ from that in the tumors from patients without the paradoxical response. Direct PCR sequencing of $G{\alpha}_s$ gene disclosed a mutant allele and a normal allele only at codon 201 in 4 of 8 tumors. The paradoxical response to TRH was observed in 2 of 4 patients without the mutation, and 2 of 4 patients with the mutation. The hTRH-R gene expression of pituitaty adenomsa did not differ between the tumors without the mutation and those with mutation. The present study suggests that the expression of TRH-R gene is not likely to be a main determinant for the paradoxical response of GH to TRH, and that $G{\alpha}_s$ mutation may suppress the gene expression of TRH-R in GH-secreting adenoma. However, a certain predisposing factor(s) may play an important role in determining the expression of TRH-R.