Home Hypothyroidism caused by the combination of two heterozygous mutations: one in the TSH receptor gene the other in the DUOX2 gene
Article
Licensed
Unlicensed Requires Authentication

Hypothyroidism caused by the combination of two heterozygous mutations: one in the TSH receptor gene the other in the DUOX2 gene

  • Mari Satoh EMAIL logo , Keiko Aso , Sayaka Ogikubo , Atsuko Yoshizawa-Ogasawara and Tsutomu Saji
Published/Copyright: September 16, 2014

Abstract

Subjects who are heterozygous for thyroid stimulating hormone receptor (TSHR) gene mutations present various phenotypes that range from euthyroid to hyperthyrotropinemia. Similarly, heterozygous dual oxidase 2 (DUOX2) gene mutations result in variable phenotypes, such as transient congenital hypothyroidism, subclinical hyperthyrotropinemia, and euthyroid in children. Here, we describe an 8-year-old boy who had normal newborn screening results, but who developed nonautoimmune hypothyroidism at the age of 1 year and 8 months of age. He was heterozygous for previously reported R450H-TSHR mutation and heterozygous for a novel double mutant allele A1323T-DUOX2 and L1343F-DUOX2. He needed levothyroxine (l-T4) replacement therapy to keep serum TSH levels within normal limits; l-T4 dose of 2.01–2.65 μg/kg/day corresponded to the dose taken by children homozygous for R450H-TSHR and by children with permanent congenital hypothyroidism. Therefore, the coexistence of a heterozygous TSHR mutation and a heterozygous DUOX2 mutation may have affected the severity of his hypothyroid condition.


Corresponding author: Mari Satoh, Department of Pediatrics, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan, E-mail:

References

1. Alberti L, Proverbio MC, Costagliola S, Romoli R, Boldrighini B, et al. Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism. J Clin Endocrinol Metab 2002;87:2549–55.10.1210/jcem.87.6.8536Search in Google Scholar

2. Camilot M, Teofoli F, Gandini A, Franceschi R, Rapa A, et al. Thyrotropin receptor gene mutations and TSH resistance: variable expressivity in the heterozygous. Clin Endocrinol (Oxf) 2005;63:146–51.10.1111/j.1365-2265.2005.02314.xSearch in Google Scholar

3. Kanda K, Mizuno H, Sugiyama Y, Imamine H, Togari H, et al. Clinical significance of heterozygous carriers associated with compensated hypothyroidism in R450H, a common inactivating mutation of the thyrotropin receptor gene in Japanese. Endocrine 2006;30:383–8.10.1007/s12020-006-0018-zSearch in Google Scholar

4. Tonacchera M, Di Cosmo C, De Marco G, Agretti P, Banco M, et al. Identification of TSH receptor mutations in three families with resistance to TSH. Clin Endocrinol (Oxf) 2007;67:712–8.10.1111/j.1365-2265.2007.02950.xSearch in Google Scholar

5. Calebiro D, Gelmini G, Cordella D, Bonomi M, Winkler F, et al. Frequent TSH receptor genetic alterations with variable signaling impairment in a large series of children with nonautoimmune isolated hyperthyrotropinemia. J Clin Endocrinol Metab 2012;97:E156–60.10.1210/jc.2011-1938Search in Google Scholar

6. Niu DM, Lin CY, Hwang B, Jap TS, Liao CJ, et al. Contribution of genetic factors to neonatal transient hypothyroidism. Arc Dis Child Fetal Neonatal Ed 2005;90:F69–72.10.1136/adc.2003.039065Search in Google Scholar

7. Avbelj M, Tahirovic H, Debeljak M, Kusekova M, Toromanovic A, et al. High prevalence of thyroid peroxidase gene mutations in patients with thyroid dyshormonogenesis. Eur J Endorinol 2007;156:511–9.10.1530/EJE-07-0037Search in Google Scholar

8. De Marco G, Agretti P, Montanelli L, Di Cosmo C, Bagattini B, et al. Identification and functional analysis of novel dual oxidase 2 (DUOX2) mutations in children with congenital or subclinical hypothyroidism. J Clin Endocrinol Metab 2011;96:E1335–9.10.1210/jc.2010-2467Search in Google Scholar

9. De Roux N, Misrahi M, Chatelain N, Gross B, Milgrom E. Microsatellites and PCR primers for genetic studies and genomic sequencing of the human TSH receptor gene. Mol Cell Endocrinol 1996;117:253–6.10.1016/0303-7207(95)03753-5Search in Google Scholar

10. Park SM, Clifton-Bligh RJ, Betts P, Chatterjee VK. Congenital hypothyroidism and apparent athyreosis with compound heterozygosity or compensated hypothyroidism with probable hemizygosity for inactivating mutations of the TSH receptor. Clin Endocrinol (Oxf) 2004;60:220–7.10.1111/j.1365-2265.2004.01967.xSearch in Google Scholar PubMed

11. Kotani T, Umeki K, Yamamoto I, Ohtai S, Adachi M, et al. Iodide organification defects resulting from cosegregation of mutated and null thyroid peroxidase alleles. Mol Cell Endocrinol 2001;182:61–8.10.1016/S0303-7207(01)00547-0Search in Google Scholar

12. Moreno JC, Bikker H, Kempers MJ, van Trotsenburg AS, Baas F, et al. Inactivating mutations in the gene for thyroid oxidase 2 (THOX2) and congenital hypothyroidism. N Engl J Med 2002;347:95–102.10.1056/NEJMoa012752Search in Google Scholar PubMed

13. Nagashima T, Murakami M, Onigata K, Morimura T, Nagashima K, et al. Novel inactivating missense mutations in the thyrotropin receptor gene in Japanese children with resistance to thyrotropin. Thyroid 2001;11:551–9.10.1089/105072501750302859Search in Google Scholar PubMed

14. Narumi S, Muroya K, Abe Y, Yasui M, Asakura Y, et al. TSHR mutations as a cause of congenital hypothyroidism in Japan: a population-based genetic epidemiology study. J Clin Endocrinol Metab 2009;94:1317–23.10.1210/jc.2008-1767Search in Google Scholar PubMed

15. Rabbiosi S, Vigone MC, Cortinovis F, Zamproni I, Fugazzola L, et al. Congenital hypothyroidism with eutopic thyroid gland: analysis of clinical and biochemical features at diagnosis and after re-evaluation. J Clin Endocrinol Metab 2013;98:1395–402.10.1210/jc.2012-3174Search in Google Scholar PubMed

16. Badano JL, Kim JC, Hoskins BE, Lewis RA, Ansley SJ, et al. Heterozygous mutations in BBS1, BBS2 and BBS6 have a potential epistatic effect on Bardet-Biedl patients with two mutations at a second BBS locus. Hum Mol Genet 2003;12:1651–9.10.1093/hmg/ddg188Search in Google Scholar PubMed

17. Hoefele J, Wolf MT, O’Toole JF, Otto EA, Schultheiss U, et al. Evidence of oligogenic inheritance in nephronophthisis. J Am Soc Nephrol 2007;18:2789–95.10.1681/ASN.2007020243Search in Google Scholar PubMed

18. Sykiotis GP, Plummer L, Hughes VA, Au M, Durrani S, et al. Oligogenic basis of isolated gonadotropin-releasing hormone deficiency. Proc Natl Acad Sci USA 2010;107:15140–4.10.1073/pnas.1009622107Search in Google Scholar PubMed PubMed Central

19. Sriphrapradang C, Tenenbaum-Rakover Y, Weiss M, Barkoff MS, Admoni O, et al. The coexistence of a novel inactivating mutant thyrotropin receptor allele with two thyroid peroxidase mutations: a genotype-phenotype correlation. J Clin Endocrinol Metab 2011;96:E1001–6.10.1210/jc.2011-0127Search in Google Scholar PubMed PubMed Central

20. Riguto S, Hoste C, Grasberger H, Milenkovic M, Communi D, et al. Activation of dual oxidase Duox 1 and Duox 2: differential regulation mediated by cAMP-dependent protein kinase and protein kinase C-dependent phospholylation. J Biol Chem 2009;284:6725–34.Search in Google Scholar

21. Narumi S, Nagasaki K, Ishii T, Muroya K, Asakura Y, et al. Nonclassic TSH resistance: TSHR mutation carriers with discrepantly high thyroid iodine uptake. J Clin Endocrinol Metab 2011;96:E1340–5.10.1210/jc.2011-0070Search in Google Scholar PubMed

22. Tonacchera M, De Marco G, Agretti P, Montanelli L, Di Cosmo C, et al. Identification and functional studies of two new dual-oxidase 2 (DUOX2) mutations in a child with congenital hypothyroidism and a eutopic normal-size thyroid gland. J Clin Endocrinol Metab 2009;94:4309–14.10.1210/jc.2009-0426Search in Google Scholar PubMed

23. Yoshizawa-Ogasawara A, Ogikubo S, Satoh M, Narumi S, Hasegwa T. Congenital hypothyroidism caused by a novel mutation of the dual oxidase 2 (DUOX2) gene. J Pediatr Endocrnol Metab 2013;26:45–52.10.1515/jpem-2012-0082Search in Google Scholar PubMed

24. Ohye H, Fukata S, Hishinuma A, Kudo T, Nishihara E, et al. A novel homozygous missense mutation of the dual oxidase 2 (DUOX2) gene in an adult patient with large goier. Thyroid 2008;18:561–6.10.1089/thy.2007.0258Search in Google Scholar PubMed

Received: 2014-2-13
Accepted: 2014-8-15
Published Online: 2014-9-16
Published in Print: 2015-5-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Obesity
  3. Childhood obesity at the crossroads
  4. Obesogenic environments: environmental approaches to obesity prevention
  5. Childhood obesity and eating behaviour
  6. Hypothalamic obesity in children: pathophysiology to clinical management
  7. The reliability of body mass index in the diagnosis of obesity and metabolic risk in children
  8. Determining abdominal obesity cut-offs and relevant risk factors for anthropometric indices in Turkish children and adolescents
  9. The effect of body mass index on blood pressure varies by race among obese children
  10. Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents
  11. Is there a relationship between cardiovascular risk factors and dehydroepiandrosterone sulfate levels in childhood obesity?
  12. The effect of lifestyle change and metformin therapy on serum arylesterase and paraoxonase activity in obese children
  13. Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study
  14. Associations between IGF-I, IGF-binding proteins and bone turnover markers in prepubertal obese children
  15. Osteocalcin is inversely associated with adiposity and leptin in adolescent boys
  16. Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children
  17. Insulin resistance and cardiometabolic risk factors in obese children and adolescents: a hierarchical approach
  18. The role of apolipoprotein E polymorphism in improving dyslipidemia in obese adolescents following physical exercise and National Cholesterol Education Program Step II intervention
  19. Review article
  20. Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome?
  21. Original articles
  22. IGF-II expression and methylation in small for gestational age infants
  23. Early screening of FTO and MC4R variants in newborns of Greek origin
  24. Pitfalls in hormonal diagnosis of 17-beta hydroxysteroid dehydrogenase III deficiency
  25. The prevalence of vitamin D deficiency among schoolchildren: a cohort study from Xinxiang, China
  26. Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines?
  27. Vitamin D status and its associations with components of metabolic syndrome in healthy children
  28. Metformin treatment improves weight and dyslipidemia in children with metabolic syndrome
  29. Patient reports
  30. Hypothyroidism caused by the combination of two heterozygous mutations: one in the TSH receptor gene the other in the DUOX2 gene
  31. Ovarian carcinoma in a 14-year-old with classical salt-wasting congenital adrenal hyperplasia and bilateral adrenalectomy
  32. An asymptomatic mother diagnosed with 3-methylcrotonyl-CoA carboxylase deficiency after newborn screening
  33. A new missense mutation in the BCKDHB gene causes the classic form of maple syrup urine disease (MSUD)
  34. Ovotesticular disorder of sex development with unusual karyotype: patient report
  35. First case report of medium-chain acyl-coenzyme A dehydrogenase deficiency in China
  36. Virilizing adrenal oncocytoma in a 9-year-old girl: rare neoplasm with an intriguing postoperative course
  37. Unexpected clinical features in a female patient with proopiomelanocortin (POMC) deficiency
  38. Sirolimus therapy in a patient with severe hyperinsulinaemic hypoglycaemia due to a compound heterozygous ABCC8 gene mutation
  39. Cross-reactivity of adrenal steroids with aldosterone may prevent the accurate diagnosis of congenital adrenal hyperplasia
  40. Hyperthyroidism hidden by congenital central hypoventilation syndrome
  41. The use of pamidronate for acute vitamin D intoxication, clinical experience with three cases
  42. Chondrocalcinosis related to familial hypomagnesemia with hypercalciuria and nephrocalcinosis
  43. Cushing syndrome related to leukemic infiltration of the central nervous system
  44. Hashimoto’s encephalopathy: a rare pediatric brain disease
  45. Short communication
  46. A novel ABCD1 gene mutation in a Chinese patient with X-linked adrenoleukodystrophy
Downloaded on 5.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2014-0078/html?lang=en
Scroll to top button