Studies of molecular mechanisms associated with increased deiodinase 3 expression in a case of consumptive hypothyroidism.

Abstract

CONTEXT:

Consumptive hypothyroidism (CH) is a rare form of hypothyroidism due to increased catabolic activity of type 3 iodothyronine deiodinase (DIO3) that can occur in large tumors. PATIENTs with CH typically present with markedly increased requirements for exogenous thyroid hormone and resolution after removal of the source of ectopic DIO3. DIO3 is encoded by DIO3, an imprinted gene expressed on the paternal allele that is located in a DIO3/delta-like 1 homolog (DLK1) gene locus regulated by a common control region, intergenic differentially methylated region (IGDMR). Because DIO3 is an imprinted gene, loss of imprinting at the IGDMR is thought to play a role in its increased expression; however, the molecular mechanism for DIO3 in CH currently is not known.

OBJECTIVE:

The aim of the study was to determine the molecular mechanism for CH in an adult patient.

SETTING:

The study was conducted in the Department of Endocrinology of a tertiary care center in Singapore.

PATIENT:

We report the case of an adult Asian female patient with a large intrathoracic fibrous tumor and severe hypothyroidism that resolved after tumor resection.

RESULTS:

The patient's tumor expressed increased levels of DIO3 and DLK1 mRNA and protein levels. Methylation-specific PCR of the IGDMR showed similar hypomethylation in placenta, thyroid, leukocytes, and tumor. Western blotting showed activation of sonic hedgehog (SHH) and MAPK signaling pathways that can increase DIO3 and DLK1 expression.

CONCLUSIONS:

Loss of imprinting did not account for overexpression of DIO3 in the patient's tumor. Instead SHH and MAPK/ERK pathway activation was associated with systemic thyroid hormone catabolism and growth of the tumor. These findings raise the possibility that other tumors that have increased SHH and MAPK/ERK signaling also may have intratumor or systemic effects on thyroid hormone function.

• Authors: Darius K L Aw, Rohit A Sinha, Hong Chang Tan, Lih Ming Loh, Domenico Salvatore, Paul M Yen
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 99 Issue 11 Pg. 3965-71 (Nov 2014) ISSN: 1945-7197 [Electronic] United States
• PMID: 24646062 (Publication Type: Clinical Conference, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• iodothyronine deiodinase type III
• Iodide Peroxidase

Topics

• Aged
• Female
• Genomic Imprinting
• Humans
• Hypothyroidism (genetics, metabolism, pathology)
• Iodide Peroxidase (genetics, metabolism)
• Solitary Fibrous Tumors (genetics, metabolism, pathology)
• Thoracic Neoplasms (genetics, metabolism, pathology)