SFEIES24 Oral Communications Oral Communications (10 abstracts)
Thyroid hormone analogue (Triac) therapy in resistance to thyroid hormone beta reduces hyperthyroid symptoms, lowers circulating thyroid hormones and metabolic rate effectively, without adverse effects
Carla Moran 1,2,3 , Julie Martin Grace 1,2 , Greta Lyons 4 , Laura Watson 5 , Kevin Taylor 6 , Sue Oddy 6 , David Halsall 6 & Krishna Chatterjee 4
1Beacon Hospital, Dublin, Ireland; 2St. Vincent’s University Hospital, Dublin, Ireland; 3University College Dublin, Dublin, Ireland; 4Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; 5NIHR Cambridge Clinical Research Facility, Cambridge, United Kingdom; 6Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
Background: The treatment of Resistance to Thyroid Hormone beta (RTHbeta) is challenging because no therapy restores the euthyroid state in all tissues. Triac (triiodothyroacetic acid), a centrally-acting thyroid hormone analogue that preferentially activates thyroid hormone receptor beta, is reported to be beneficial in case reports or small case series.
Methods: We have treated a cohort of adult RTHbeta patients, all with heterozygous mutations in THRB and hyperthyroid symptoms, with Triac for up to a decade. Here, we describe the clinical, biochemical, metabolic and cardiac responses to therapy. Patients in whom the HPT axis was altered (due to ATDs, thyroid surgery or radioiodine) were excluded.
Results: A total of eight adult patients (aged 18-54 years, 4 female) were treated with Triac. Median Triac dose used was 2.4 mg per day (range 1.4-3.5 mg) and duration of therapy varied from <1 yr to 12 years. Response to therapy was analysed (Biochemistry, HSS: Hyperthyroid Symptoms Score, SHR: sleeping heart rate, REE: resting energy expenditure). 7 of 8 patients achieved normal circulating FT4 (measured by immunoassay; mean FT4 fell from 31.2 pmol/l to 18.3 pmol/l, RR 10.5-21) and 5 of 6 achieved normal total T3 concentrations (measured by LC-TMS; mean TT3 fell from 2.89 to 1.52 nmol/l, RR 1.09-2.24). Mean reductions in other parameters included; HSS reduction from 17/40 to 9/40, SHR reduction from 60 to 56bpm, REE (measured as Z score) fell from +1.375 to +0.66. Triac was well tolerated and there were no reported side effects. No patients discontinued therapy.
Conclusions: Triac therapy in RTHbeta reduces hyperthyroid symptoms, lowers circulating FT4 and TT3 concentrations and reduces basal metabolic and heart rate effectively, without adverse effects. Whether longer-term Triac treatment alters adverse cardiovascular outcomes recently associated with RTHbeta remains to be determined.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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