Syndrome of resistance to the thyroid hormones

In the adult, the daily needs of thyroid hormones are between 1.5 to 1.7 micro g/kg. In some conditions, these needs can be more important. We report the case of a woman with primary hypothyroidism that necessitated large doses of L-thyroxine. This female patient, age 47, without a family history of thyroid disease, was hospitalized in 1988 because of hypothyroidism [she had no goiter] and iron deficiency anemia. The patient was started on L-thyroxine with a dose of 150 micro g/ day [2.7micro g/kg/day] but the dose had to be increased to 650 micro g/day [12 micro g/kg/day] to obtain clinical and biological euthyroidism [TSH of l.3 microUI/L]. Six years later, while still receiving 650 micro g/day of L-thyroxine, the patient presented with signs of hyperthyroidism with a TSH of 0.01 microUI/L. The doses were progressively decreased to 125 micro g/day [2.3micro g/kg/day] over a five year period and the TSH was back to normal [0.9 micro UI/l] with clinical euthyroidism. This clinical picture is compatible with a syndrome of resistance to the thyroid hormones and the more so because transient forms similar to our case have been reported in the literature

[Tuberculomas intrasellaires: about 2 cases]

Sellar tuberculomas are extremely rare. Their diagnosis is difficult because other intrasellar lesions may have the same clinical and radiological appearance. We report two cases, in which the diagnosis was made on the basis of clinical, paraclinical and therapeutic arguments. The first observation is a 42-year-old unmarried woman who presented with central diabetes insipidus and secondary amenorrhoea. Magnetic resonance imaging [MRI] revealed a nodular thickening of the pituitary stalk, an increased size of the pituitary gland and a loss of the posterior pituitary hyperintensity signal at T1. The tubercular origin of these lesions was deducted from the presence of tubercle Bacillus in the bronchial fluid, and the favourable evolution after anti tubercular treatment. The second observation is a 29-year-old woman with secondary amenorrhoea at the 12th month of treatment for tubercular pleuropulmonary lesions and meningitis confirmed by the presence of Tubercle Bacillus in the cerebrospinal fluid. The MRI revealed a multinodular expansive processus that encircled the pituitary stalk and extended to the infuncibular and hypothalamic regions. These nodules regressed with continuation of the same antitubercular treatment