Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- weakness
- fatigue
- cold intolerance
Other diagnostic factors
- decreased memory
- constipation
- muscle cramps
- weight gain
- depression
- dry, coarse skin
- oligomenorrhoea/amenorrhoea
- bradycardia
- reduced body and scalp hair
- delayed relaxation of deep tendon reflexes
- hearing impairment
- impassive facial expression
- diabetes insipidus (DI)
- headache
- diplopia
- decreased peripheral vision
- skin depigmentation
- atrophic breasts
- galactorrhoea
Risk factors
- multiple endocrine neoplasia (MEN) type I
- age - between 5-14 years and older than 65 (craniopharyngiomas)
- age - second to fifth decades (prolactinomas)
- age - fourth to eighth decades (non-functioning pituitary adenomas)
- sarcoidosis
- head and neck irradiation
- traumatic brain injury (TBI)
- histiocytosis
- haemochromatosis
- pregnancy
- family history of central hypothyroidism
Diagnostic investigations
1st investigations to order
- serum free thyroxine (T4)
- serum thyroid-stimulating hormone (TSH)
Investigations to consider
- MRI of brain
- CT head
- prolactin (PRL)
- 9 a.m. serum cortisol
- serum testosterone
- serum gonadotrophins
- genetic analyses
Treatment algorithm
all patients
Contributors
Authors
Jacqueline Gilbert, PhD, MRCP
Consultant Endocrinologist
King's College Hospital NHS Foundation Trust
London
UK
Disclosures
JG declares that she has no competing interests.
Acknowledgements
Dr Jacqueline Gilbert would like to gratefully acknowledge Dr Rasa Zarnegar, a previous contributor to this topic.
Disclosures
RZ declares that he has no competing interests.
Peer reviewers
James Lee, MD
Assistant Professor
Department of Endocrine Surgery
Columbia University
New York
NY
Disclosures
JL declares that he has no competing interests.
James V. Hennessey, MD
Director of Clinical Endocrinology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
JVH declares that he has no competing interests.
Anthony Weetman, MD, DSc, FRCP, FMedSci
Sir Arthur Hall Professor of Medicine/Pro Vice Chancellor
University of Sheffield
Sheffield
UK
Disclosures
AW declares that he has no competing interests.
Differentials
- Primary hypothyroidism
- Non-thyroidal illness
- Iodine deficiency
More DifferentialsGuidelines
- Guidelines on the diagnosis and management of central hypothyroidism
- Hypothalamic-pituitary and growth disorders in survivors of childhood cancer
More GuidelinesPatient leaflets
Underactive thyroid
Underactive thyroid: questions to ask your doctor
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer