Goiter is common in GTHR. Delayed speech
development, mental retardation, and delayed skeletal maturation represent
subtle signs of hypothyroidism. Florid clinical signs and symptoms of
hypothyroidism are unusual. Attention deficit disorder is commonly
associated with GTHR. GTHR has been erroneously diagnosed as thyrotoxicosis
on the basis of laboratory investigations; however, GTHR does not
demonstrate depression of thyroid-stimulating hormone levels as is seen in
thyrotoxicosis. Treatment is not required for GTHR except in the presence of
growth retardation or delayed skeletal maturation. PTHR results in loss of
negative feedback to the pituitary with normal peripheral tissue response to
thyroxine causing clinical hyperthyroidism which has been treated
successfully with d-thyroxine. The condition should be distinguished
from a primary pituitary thyroid-stimulating hormone-secreting tumor.