Central Hypothyroidism in Adults: Better Understanding for Better Care

Overview

Journal Pituitary

Specialty Endocrinology

Date 2014 Feb 21

PMID 24554165

Citations 8

Authors

Solange Grunenwald

Philippe Caron

Affiliations

Soon will be listed here.

Abstract

Central hypothyroidism (CH) is a rare cause of hypothyroidism generally related to a hypothalamic-pituitary disorder or arising as an iatrogenic complication. In adults, CH may be secondary to quantitative and/or qualitative alterations in thyroid-stimulating hormone (TSH) secretion. The disease is difficult to diagnose clinically because it lacks specific clinical signs and these may be masked by other anterior pituitary hormone secretion deficiencies. In patients with long-standing and marked CH, a diagnosis may be made based on low free T4 levels and normal, low or moderately increased TSH levels. In patients with early-stage or moderate CH, exploration of the circadian TSH cycle, determination of TSH response after a TRH test or recombinant TSH injection, estimation of TSH index, or evaluation of peripheral indexes of thyroid hormone metabolism may be required to establish a diagnosis. Regarding treatment, patients should receive levothyroxine replacement therapy, but hormone objectives during follow-up need to be precisely determined in order to reduce cardiovascular risks and to improve the quality of life of patients.

Citing Articles

Diagnosing and treating the elderly individual with hypopituitarism.

Corsello A, Paragliola R, Salvatori R Rev Endocr Metab Disord. 2023; 25(3):575-597.

PMID: 38150092 DOI: 10.1007/s11154-023-09870-w.

Epidemiology, Types, Causes, Clinical Presentation, Diagnosis, and Treatment of Hypothyroidism.

Zamwar U, Muneshwar K Cureus. 2023; 15(9):e46241.

PMID: 37908940 PMC: 10613832. DOI: 10.7759/cureus.46241.

The TRH test provides valuable information in the diagnosis of central hypothyroidism in patients with known pituitary disease and low T4 levels.

Christensen S, Smith L, Rosendal C, Gulisano H, Ettrup K, Vestergaard P Front Endocrinol (Lausanne). 2023; 14:1226887.

PMID: 37850100 PMC: 10577283. DOI: 10.3389/fendo.2023.1226887.

Interactions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions.

Feldt-Rasmussen U, Klose M, Benvenga S Endocrine. 2018; 62(3):519-527.

PMID: 30191443 DOI: 10.1007/s12020-018-1738-6.

Central hypothyroidism - a neglected thyroid disorder.

Beck-Peccoz P, Rodari G, Giavoli C, Lania A Nat Rev Endocrinol. 2017; 13(10):588-598.

PMID: 28549061 DOI: 10.1038/nrendo.2017.47.

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