The Journal of Clinical Endocrinology and Metabolism Journal Article

Genetics of Congenital Isolated TSH Deficiency: Mutation Screening of the Known Causative Genes and a Literature Review

July 24, 2019

Chiho Sugisawa, Tetsuya Takamizawa, Kiyomi Abe, Tomonobu Hasegawa, Kentaro Shiga, Hidenori Sugawara, Koji Ohsugi, Koji Muroya, Yumi Asakura, Masanori Adachi, Takashi Daitsu, Chikahiko Numakura, Akemi Koike, Junko Tsubaki, Kazuteru Kitsuda, Nobuo Matsuura, Matsuo Taniyama, Sumiyasu Ishii, Tetsurou Satoh, Masanobu Yamada, Satoshi Narumi
The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 12, December 2019, Pages 6229–6237
https://doi.org/10.1210/jc.2019-00657

Abstract

Context

Congenital isolated TSH deficiency (i-TSHD) is a rare form of congenital hypothyroidism. Five genes (IGSF1, IRS4, TBL1X, TRHR, and TSHB) responsible for the disease have been identified, although their relative frequencies and hypothalamic/pituitary unit phenotypes have remained to be clarified.

Objective

To define the relative frequencies and hypothalamic/pituitary unit phenotypes of congenital i-TSHD resulting from single gene mutations.

Patients and Methods

Thirteen Japanese patients (11 boys and 2 girls) with congenital i-TSHD were enrolled. IGSF1, IRS4, TBL1X, TRHR, and TSHB were sequenced. For a TBL1X mutation (p.Asn382del), its pathogenicity was verified in vitro. For a literature review, published clinical data derived from 74 patients with congenital i-TSHD resulting from single-gene mutations were retrieved and analyzed.

Results

Genetic screening of the 13 study subjects revealed six mutation-carrying patients (46%), including five hemizygous IGSF1 mutation carriers and one hemizygous TBL1X mutation carrier. Among the six mutation carriers, one had intellectual disability and the other one had obesity, but the remaining four did not show nonendocrine phenotypes. Loss of function of the TBL1X mutation (p.Asn382del) was confirmed in vitro. The literature review demonstrated etiology-specific relationship between serum prolactin (PRL) levels and TRH-stimulated TSH levels with some degree of overlap.

Conclusion

The mutation screening study covering the five causative genes of congenital i-TSHD was performed, showing that the IGSF1 defect was the leading genetic cause of the disease. Assessing relationships between serum PRL levels and TRH-stimulated TSH levels would contribute to predict the etiologies of congenital i-TSHD.

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