Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism

Luisella Alberti, Maria Carla Proverbio, Sabine Costagliola, Roberto Romoli, Benedetta Boldrighini, Maria Cristina Vigone, Giovanna Weber, Giuseppe Chiumello, Paolo Beck-Peccoz, Luca Persani

Research output: Contribution to journalArticle

Abstract

Germline loss-of-function mutations of TSH receptor (TSHR) gene have been described in families with partial or complete TSH resistance. Large TSH elevations were generally found in the patients with homozygous or compound heterozygous mutations. In this study, we sequenced the entire TSHR gene in a series of 10 unrelated patients with slight (6.6-14.9 mU/liter) to moderate (24-46 mU/liter) elevations of serum TSH, associated with definitely normal free thyroid hormone concentrations. Thyroid volume was normal in all patients, except two with a modest hypoplasia. Autoimmune thyroid disease was excluded in all patients on the basis of clinical and biochemical parameters. Eight patients had at least one first-degree relative bearing the same biochemical picture. TSHR mutations were detected in 4 of 10 cases by analyzing DNA from peripheral leukocytes. A compound heterozygosity (P162A on maternal allele, and the novel mutation C600R on the paternal one) was found in the patient with the highest TSH levels. Only one TSHR allele was mutated in the remaining three cases, and no alterations in TSHR gene promoter were detected in all of these probands. A novel mutation (L467P) was detected on the maternal allele in one patient and in her monozygotic twin. Previously described inactive mutants, T655Δ and C41S, were detected in the other two cases. When tested on several occasions, circulating TSH values fluctuating above the upper limit of the normal range could be shown in heterozygous subjects of these families. A dominant mode of inheritance of the biochemical alterations was detected in these cases. Mutant TSHRs were studied during transient expression in COS7 and HEK293T cells. Their TSH-independent cAMP accumulation activities were very low or similar to mock-transfected cells, and no increases were seen after maximal hormone stimulation. Flow eytometry experiments showed a poor level of expression of all mutant TSHRs at the cell membrane. In conclusion, we found several loss-of-function mutations of TSHR, including two novel ones, in a series of unrelated patients with slightly elevated TSH levels. Therefore, partial resistance to TSH action is a frequent finding among patients with slight hyperthyrotropinemia of non-autoimmune origin. Germline mutations of TSHR may be associated with serum TSH values fluctuating above the upper limit of the normal range, also in the heterozygous state.

Original languageEnglish
Pages (from-to)2549-2555
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume87
Issue number6
DOIs
Publication statusPublished - 2002

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Thyrotropin Receptors
Germ-Line Mutation
Genes
Mutation
Alleles
Bearings (structural)
Reference Values
Mothers
Cell membranes
Hypothyroidism, Congenital, Nongoitrous, 1
Thyroid Hormones
Monozygotic Twins
Thyroid Diseases
Serum
Hormones
Autoimmune Diseases
Thyroid Gland
Leukocytes
Cell Membrane
DNA

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism. / Alberti, Luisella; Proverbio, Maria Carla; Costagliola, Sabine; Romoli, Roberto; Boldrighini, Benedetta; Vigone, Maria Cristina; Weber, Giovanna; Chiumello, Giuseppe; Beck-Peccoz, Paolo; Persani, Luca.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 87, No. 6, 2002, p. 2549-2555.

Research output: Contribution to journalArticle

Alberti, L, Proverbio, MC, Costagliola, S, Romoli, R, Boldrighini, B, Vigone, MC, Weber, G, Chiumello, G, Beck-Peccoz, P & Persani, L 2002, 'Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism', Journal of Clinical Endocrinology and Metabolism, vol. 87, no. 6, pp. 2549-2555. https://doi.org/10.1210/jc.87.6.2549
Alberti, Luisella ; Proverbio, Maria Carla ; Costagliola, Sabine ; Romoli, Roberto ; Boldrighini, Benedetta ; Vigone, Maria Cristina ; Weber, Giovanna ; Chiumello, Giuseppe ; Beck-Peccoz, Paolo ; Persani, Luca. / Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism. In: Journal of Clinical Endocrinology and Metabolism. 2002 ; Vol. 87, No. 6. pp. 2549-2555.
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abstract = "Germline loss-of-function mutations of TSH receptor (TSHR) gene have been described in families with partial or complete TSH resistance. Large TSH elevations were generally found in the patients with homozygous or compound heterozygous mutations. In this study, we sequenced the entire TSHR gene in a series of 10 unrelated patients with slight (6.6-14.9 mU/liter) to moderate (24-46 mU/liter) elevations of serum TSH, associated with definitely normal free thyroid hormone concentrations. Thyroid volume was normal in all patients, except two with a modest hypoplasia. Autoimmune thyroid disease was excluded in all patients on the basis of clinical and biochemical parameters. Eight patients had at least one first-degree relative bearing the same biochemical picture. TSHR mutations were detected in 4 of 10 cases by analyzing DNA from peripheral leukocytes. A compound heterozygosity (P162A on maternal allele, and the novel mutation C600R on the paternal one) was found in the patient with the highest TSH levels. Only one TSHR allele was mutated in the remaining three cases, and no alterations in TSHR gene promoter were detected in all of these probands. A novel mutation (L467P) was detected on the maternal allele in one patient and in her monozygotic twin. Previously described inactive mutants, T655Δ and C41S, were detected in the other two cases. When tested on several occasions, circulating TSH values fluctuating above the upper limit of the normal range could be shown in heterozygous subjects of these families. A dominant mode of inheritance of the biochemical alterations was detected in these cases. Mutant TSHRs were studied during transient expression in COS7 and HEK293T cells. Their TSH-independent cAMP accumulation activities were very low or similar to mock-transfected cells, and no increases were seen after maximal hormone stimulation. Flow eytometry experiments showed a poor level of expression of all mutant TSHRs at the cell membrane. In conclusion, we found several loss-of-function mutations of TSHR, including two novel ones, in a series of unrelated patients with slightly elevated TSH levels. Therefore, partial resistance to TSH action is a frequent finding among patients with slight hyperthyrotropinemia of non-autoimmune origin. Germline mutations of TSHR may be associated with serum TSH values fluctuating above the upper limit of the normal range, also in the heterozygous state.",
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AU - Boldrighini, Benedetta

AU - Vigone, Maria Cristina

AU - Weber, Giovanna

AU - Chiumello, Giuseppe

AU - Beck-Peccoz, Paolo

AU - Persani, Luca

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