Resistance to Thyroid Hormone in a Boy with a Severe, Complex, Congenital Heart Defect (CHD) Requiring Multiple Cardiac Surgeries-Whether and How to Prepare Child for the Surgery

一名患有严重、复杂、先天性心脏缺陷 (CHD) 的男孩出现甲状腺激素抵抗,需要进行多次心脏手术 - 是否以及如何为孩子做好手术准备

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作者:Anna Fedorczak, Beata Kruk, Anna Mazurek-Kula, Łukasz Kępczyński, Renata Stawerska

Background

Resistance to thyroid hormones (RTH) is a rare, genetically determined disease characterised by reduced tissue sensitivity to thyroid hormones (THs). It is caused by mutations in genes encoding the receptors for thyroid hormones, α (THRα) or β (THRβ), the distribution of which varies between tissues. Therefore, patients present with elevated TH levels with unsuppressed TSH levels, and symptoms of both hypothyroidism and hyperthyroidism may be present.

Conclusions

The management of RTH is a constant challenge for clinicians and must be individualised.

Methods

Hence, we report the case of a boy with a complex, cyanotic, congenital heart defect who was also diagnosed with TH resistance syndrome.

Results

Because of the clinical features of hyperthyroidism in preparation for cardiac surgery, thiamazole was administered, resulting in the normalisation of TH effects on the α-receptor for HTs. Due to the effectiveness of the proposed treatment, it was further introduced before the further stages of cardiac surgeries. Conclusions: The management of RTH is a constant challenge for clinicians and must be individualised.

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