Three cases of transient hyperthyroidism after triptorelin treatment – case report and literature review

Abstract

The impacts of gonadtropin-releasing hormone (GnRH) agonists on thyroid function have long been observed and the conclusions were controversial. We here reported three cases of transient hyperthyroidisms after triptorelin therapy. The three patients showed decreased thyroid-stimulating hormone (TSH), with or without elevated free triiodothyronine (FT3) and free thyroxine (FT4) 2 weeks after injection of triptorelin. Thyroid-specific autoantibody assays showed antithyroid microsome autoantibody (TMAb) and (or) antithyroglobulin autoantibody (TgAb) were positive in two patients while and antithyrotropin receptor autoantibody (TRAb) were negative in all three cases. One patient with all thyroid-specific autoantibodies negative showed enlarged thyroid in thyroid ultrasound scanning. Only mild symptoms of hyperthyroidism presented in one patient. Four weeks after triptorelin injection, thyroid function returned to normal in all three patients. These observations indicated transient hyperthyroidism due to thyroid destruction in patients receive triptorelin therapy. The hyperthyroidism was most possibly due to onset of the autoimmune thyroiditis, emphasizing monitoring thyroid function during triptorelin treatment in females.

Chinese abstract

长期观察到促性腺激素释放激素（GnRH）激动剂对甲状腺功能有影响, 但此结论仍存在争议。 本文报道了曲普瑞林治疗后发生了三例短暂性甲状腺功能亢进。三名患者在注射曲普瑞林2周后显示促甲状腺激素（TSH）降低, 伴或不伴游离三碘甲腺原氨酸（FT3）和游离甲状腺素（FT4）的升高。甲状腺特异性自身抗体检测显示2名患者的抗甲状腺微粒体自身抗体（TMAb）和（或）抗甲状腺球蛋白自身抗体（TgAb）阳性, 而3名患者抗甲状腺刺激素受体自身抗体（TRAb）均为阴性。所有甲状腺特异性自身抗体均为阴性的一名患者在甲状腺超声扫描中显示甲状腺增大。只有一名患者有轻度甲状腺功能亢进的症状。曲普瑞林注射4周后, 3名患者的甲状腺功能均恢复正常。这些观察结果表明, 接受曲普瑞林治疗后的患者因甲状腺破坏引起短暂性甲状腺功能亢进。甲状腺功能亢进最可能是由于自身免疫性甲状腺炎的发作引起, 强调在应用曲普瑞林治疗女性期间应监测甲状腺功能。

Keywords:

• Gonadotropin-releasing hormone agonist
• triptorelin
• autoimmune thyroid disease

Disclosure statement

The authors declare that they have no conflicts of interest.

Additional information

Funding

This study has been funded by National Natural Science Foundation of China (NSFC H0707/81100555) and Jiangsu Health International Exchange Program from Jiangsu Commitment of Health and Family Plan to X. W.