Thyroid Hormone Resistance via the THRB Gene
Summary and Pricing 
Test Method
Sequencing and CNV Detection via NextGen Sequencing using PG-Select Capture Probes
| Test Code | Test Copy Genes | Test CPT Code | Gene CPT Codes Copy CPT Code | Base Price | |
|---|---|---|---|---|---|
| 15203 | THRB | 81405 | 81405,81479 | $990 | Order Options and Pricing |
Pricing Comments
Testing run on PG-select capture probes includes CNV analysis for the gene(s) on the panel but does not permit the optional add on of exome-wide CNV analysis. Any of the NGS platforms allow reflex to other clinically relevant genes, up to whole exome or whole genome sequencing depending upon the base platform selected for the initial test.
An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.
This test is also offered via a custom panel (click here) on our exome or genome backbone which permits the optional add on of exome-wide CNV or genome-wide SV analysis.
Turnaround Time
3 weeks on average for standard orders or 2 weeks on average for STAT orders.
Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.
Targeted Testing
For ordering sequencing of targeted known variants, go to our Targeted Variants page.
Clinical Features and Genetics
Clinical Features
Thyroid hormone resistance (THR) is a rare genetic disorder caused by reduced tissue responsiveness to thyroid hormone. The estimated prevalence is about 1:40,000 births. The characteristic biochemical findings in patients with THR are elevated serum free thyroid hormone levels accompanied by nonsuppressed thyroid stimulating hormone production (Dumitrescu et al. 2013). The clinical presentation is highly variable and has a mixture of hypothyroidism and hyperthyroidism because of variable peripheral resistance among individuals as well as among different tissues within a single patient. Goiter is often found in 66-95% of reported cases. Symptoms related to hypothyroidism include learning disabilities, delayed growth and bone development. Hyperactivity and tachycardia are associated with high thyroid hormone levels. In the mild form of THR, isolated biochemical abnormalities may be the only findings (Dumitrescu et al. 2013; Ferrara et al. 2012; Amor et al. 2014). A defect in the thyroid hormone receptor beta gene (THRB) accounts for almost 85% of THR cases. Heterozygous mutations in the thyroid hormone receptor alpha gene (THRA) lead to a rare form of THR with congenital hypothyroidism as a predominant clinical presentation (Mullem et al. 2014).
Genetics
THRB-associated THR usually is an autosomal dominant condition secondary to dominant-negative pathogenic variants. Less commonly, it can be a recessive disorder due to loss-of-function mutations (Ferrara et al. 2012, Dumitrescu et al. 2013). De novo mutations occur in ~23% of cases, and mosaicism has been observed (Mamanasiri et al. 2012; Amor et al. 2014). The THRB gene encodes a nuclear receptor of thyroid hormone that is bound to thyroid hormone response elements of target genes and functions as a ligand-dependent transcription factor (Dumitrescu et al. 2013). Missense is the major type of documented THRB pathogenic variants. Nonsense, small deletion/insertions, and gross deletions have also been reported (Amor et al. 2014; Ferrara et al. 2012).
Clinical Sensitivity - Sequencing with CNV PG-Select
Over 85% of cases of thyroid hormone resistance (THR) are caused by THRB pathogenic variants. Gross deletions affecting multi- exons of THRB are rare and result in the recessive form of THR (Dumitrescu et al. 2013).
Testing Strategy
This test is performed using Next-Generation sequencing with additional Sanger sequencing as necessary.
This test provides full coverage of all coding exons of the THRB gene, plus ~10 bases of flanking noncoding DNA. We define full coverage as >20X NGS reads or Sanger sequencing.
Indications for Test
Individuals with clinical symptoms consistent with thyroid hormone resistance and absence of anti-thyroid antibodies. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in THRB.
Individuals with clinical symptoms consistent with thyroid hormone resistance and absence of anti-thyroid antibodies. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in THRB.
Gene
| Official Gene Symbol | OMIM ID |
|---|---|
| THRB | 190160 |
| Inheritance | Abbreviation |
|---|---|
| Autosomal Dominant | AD |
| Autosomal Recessive | AR |
| X-Linked | XL |
| Mitochondrial | MT |
Diseases
Citations
- Amor AJ, Halperin I, Alfayate R, Borrás VM, Escribano A, González C, Gutirrez A, Mauri M, Pérez P, Pic? A, Vourliotaki I, Oriola J. 2014. Identification of four novel mutations in the thyroid hormone receptor-? gene in 164 Spanish and 2 Greek patients with resistance to thyroid hormone. Hormones (Athens) 13: 74–78. PubMed ID: 24722129
- Dumitrescu AM, Refetoff S. 2013. The syndromes of reduced sensitivity to thyroid hormone. Biochim. Biophys. Acta 1830: 3987–4003. PubMed ID: 22986150
- Ferrara AM, Onigata K, Ercan O, Woodhead H, Weiss RE, Refetoff S. 2012. Homozygous thyroid hormone receptor ?-gene mutations in resistance to thyroid hormone: three new cases and review of the literature. J. Clin. Endocrinol. Metab. 97: 1328–1336. PubMed ID: 22319036
- Mamanasiri S, Yesil S, Dumitrescu AM, Liao X-H, Demir T, Weiss RE, Refetoff S. 2006. Mosaicism of a thyroid hormone receptor-beta gene mutation in resistance to thyroid hormone. J. Clin. Endocrinol. Metab. 91: 3471–3477. PubMed ID: 16804041
- Mullem AA van, Visser TJ, Peeters RP. 2014. Clinical Consequences of Mutations in Thyroid Hormone Receptor-?1. Eur Thyroid J 3: 17–24. PubMed ID: 24847461
Ordering/Specimens
Ordering Options
We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.
myPrevent - Online Ordering
- The test can be added to your online orders in the Summary and Pricing section.
- Once the test has been added log in to myPrevent to fill out an online requisition form.
- PGnome sequencing panels can be ordered via the myPrevent portal only at this time.
Requisition Form
- A completed requisition form must accompany all specimens.
- Billing information along with specimen and shipping instructions are within the requisition form.
- All testing must be ordered by a qualified healthcare provider.
For Requisition Forms, visit our Forms page
If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.
Specimen Types
Specimen Requirements and Shipping Details
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ORDER OPTIONS
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