Thyroid hormone resistance (also resistance to thyroid hormone (RTH), and sometimes Refetoff syndrome) describes a rare syndrome in which the thyroid hormone levels are elevated but the thyroid stimulating hormone (TSH) level is not suppressed, or not completely suppressed as would be expected. The first report of the condition appeared in 1967. Essentially this is decreased end organ responsiveness to thyroid hormones. A new term "impaired sensitivity to thyroid hormone" has been suggested in March 2014 by Refetoff et al. Presentation
The syndrome can present with variable symptoms, even between members of the same family harboring the same mutation. Typically most or all tissues are resistant to thyroid hormone, so despite raised measures of serum thyroid hormone the individual may appear euthyroid (have no symptoms of over- or underactivity of the thyroid gland). The most common symptoms are goiter and tachycardia. It has also been linked to some cases of attention deficit hyperactivity disorder (ADHD), although the majority of people with that diagnosis have no thyroid problems. An association with depression has been proposed. Causes
Normal thyroid hormone function requires normal thyroid hormone transport across cell membrane, appropriate deiodination, thyroid hormone nuclear receptor, thyroid hormone response elements, co-activators, co-repressors, and normal histone acetylation.
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbinss pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inflamed necrotic tissue." Common forms of ulcers recognized in medicine include:
Ulcer (dermatology), a discontinuity of the skin or a break in the skin. Pressure ulcers, also known as bedsores
Genital ulcer, an ulcer located on the genital area
Ulcerative dermatitis, a skin disorder associated with bacterial growth often initiated by self-trauma
Anal fissure, a.k.a. an ulcer or tear near the anus or within the rectum
Diabetic foot ulcer, a major complication of the diabetic foot
Corneal ulcer, an inflammatory or infective condition of the cornea
Mouth ulcer, an open sore inside the mouth. Aphthous ulcer, a specific type of oral ulcer also known as a canker sore
Peptic ulcer, a discontinuity of the gastrointestinal mucosa (stomach ulcer)
Venous ulcer, a wound thought to occur due to improper functioning of valves in the veins
Stress ulcer, an ulcer located  within the stomach and proximal duodenum
Ulcerative sarcoidosis, a cutaneous condition affecting people with sarcoidosis
Ulcerative lichen planus, a rare variant of lichen planus
Ulcerative colitis, a form of inflammatory bowel disease (IBD). Ulcerative disposition, a disorder or discomfort that causes severe abdominal distress, often associated with chronic gastritis

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