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Central hypothyroidism in adults: better understanding for better care

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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.

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  1. Cardiovascular and Metabolic Unit, Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France

    Solange Grunenwald & Philippe Caron

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  1. Solange Grunenwald
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  2. Philippe Caron
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Correspondence to Philippe Caron.

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Grunenwald, S., Caron, P. Central hypothyroidism in adults: better understanding for better care. Pituitary 18, 169–175 (2015). https://doi.org/10.1007/s11102-014-0559-8

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