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Pituitary

, Volume 18, Issue 1, pp 169–175 | Cite as

Central hypothyroidism in adults: better understanding for better care

  • Solange Grunenwald
  • Philippe CaronEmail author
Article

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.

Keywords

Central hypothyroidism Pathophysiology Causes Diagnosis Treatment Levothyroxine Free T4 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Cardiovascular and Metabolic Unit, Department of Endocrinology and Metabolic DiseasesCHU LarreyToulouse CedexFrance

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