In acute and chronic hyperthyroid patients, clinical symptoms may not always reflect their thyroid hormone status. After normalization of serum thyroid hormone concentrations in these patients, some symptoms caused by hyperthyroidism may remain unchanged (1). Even in subclinical hyperthyroid patients, functional recovery after restoration to euthyroidism is sometimes incomplete (2). The underlying mechanisms of such incomplete recovery are not yet fully understood. Indeed, functional adaptation or irreversible alteration may be induced during exposure to excess thyroid hormone. The liver is a representative target organ of thyroid hormone action, where T3 regulates various hepatic functions including cholesterol, triglyceride, and carbohydrate metabolism (3). To accomplish this, T3 regulates the expression of many rate-limiting enzymes of such metabolic pathways. In addition, thyroid hormone signaling activates autophagy, which plays a key role in regulating lipid metabolism, mitochondrial quality, and various proteins regulating metabolic pathways in hepatocytes (4). Thus, dysregulation of thyroid hormone action in liver may induce serious clinical conditions such as nonalcoholic fatty liver disease (5). To examine the role of thyroid hormone on the expression of hepatic genes, several groups have applied DNA microarray analysis to the hepatic gene expression profile (6). In these studies, it has become clear that the transcriptomic response is different between acute and chronic T3 treatment (7). However, the expression profile of T3-sensitive genes after amelioration of hyperthyroidism has not yet been studied. In this issue of Endocrinology, Ohba et al (8) examined the effects of a single T3 injection, chronic T3 injections (14 d), or chronic injections followed T3 withdrawal for 10 days on the hepatic gene expression profile of adult male mice using gene expression microarrays. Because they used a large dose of T3 (20 g/100 g body weight), all mice became hyperthyroid, which was confirmed by suppressed TSH levels. TSH levels then increased transiently 5 days after the last T3 injection, before normalizing by 10 days. They identified 680 genes that were induced by either a single or chronic injection of T3. Interestingly, only 10% of these genes were induced by both treatments, indicating that most acutely induced T3-sensitive genes became desensitized to the administration dose over time. Furthermore, 10% of genes did not return to normal levels of expression despite normalization of thyroid hormone concentrations after T3 withdrawal. Although Ohba et al (8) found many genes that were altered by T3 treatment or its withdrawal, such genes may not be directly regulated by thyroid hormone. Thus, they studied further the expression of 8 genes (B cell lymphoma 3 [Bcl3], cytochrome P450 17 -hydroxylase [Cyp17a1], Cyp 17,20-lyase [Cpt1a], fatty acid synthase [Fasn], fibroblast growth factor 21 [Fgf21], isocitrate dehydrogenase 3 [Idh3a], thyroid hormone-responsive protein [Thrsp], and type-1 iodothyronine deiodinase [Dio1]) thought to have functional thyroid hormone response elements. Interestingly, despite this, the expression pattern was not always the same. Among 6 genes that were induced by acute T3 treatment (Bcl3, Cpt1a, Dio1, Fasn, Idh3a, and Thrsp), the expression of 4 genes (Bcl3, Cpt1a, Fasn, and Thrsp) was not elevated after 14 days of T3 treatment, indicating desensitization by chronic treatment, whereas both Dio1 and Idh3a were induced by both
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