Central hypothyroidism

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Última revisão das evidências: 6 Oct 2026

Última atualização do tópico: 17 Jan 2023

Symptoms of central hypothyroidism are similar to those of primary hypothyroidism (including fatigability, cold intolerance, weight gain, and depression), and may or may not be accompanied by symptoms of hypopituitarism, such as those of hypogonadism (i.e., decreased libido, infertility) and secondary adrenal insufficiency (i.e., weakness, nausea, vomiting).

Signs of central hypothyroidism on physical examination would also be similar to those of primary hypothyroidism and may include dry skin, hair loss, bradycardia, and delayed deep tendon reflexes.

Specific signs suggestive of a sellar or parasellar mass include papilledema and bitemporal hemianopia.

Diagnostic evaluation of central hypothyroidism includes serum thyroid-stimulating hormone (TSH) and free thyroxine (T4) concentrations. In central hypothyroidism, free T4 is low and TSH may be low, normal, or minimally elevated. Magnetic resonance imaging may reveal a sellar or parasellar mass or infiltrative disorder.

Treatment of central hypothyroidism is by thyroid hormone replacement (levothyroxine).

Complications of treatment may include thyrotoxicosis and osteoporosis.

Definição

Hypothyroidism is a condition resulting from the deficiency of thyroid hormones, which leads to a generalized slowing of metabolic processes. Central hypothyroidism arises from an anatomic or functional disorder of the pituitary gland and/or the hypothalamus. This decreases thyroid-stimulating hormone secretion, leading in turn to decreased thyroid hormone synthesis and release.[1] Central hypothyroidism may be due to congenital, neoplastic, inflammatory, infiltrative, traumatic, or iatrogenic etiologies.

História e exame físico

Principais fatores diagnósticos

weakness
fatigue
cold intolerance

Detalhes completos

Outros fatores diagnósticos

decreased memory
constipation
muscle cramps
weight gain
depression
dry, coarse skin
oligomenorrhea/amenorrhea
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
atrophic breasts
galactorrhea
moon facies
buffalo hump

Detalhes completos

Fatores de risco

presence of pituitary mass lesions
multiple endocrine neoplasia (MEN) type I
head and neck irradiation
traumatic brain injury (TBI)
age between 5-15 years and 45-60 years (craniopharyngiomas)
age 20-50 years (prolactinomas)
age 40-80 years (nonfunctioning pituitary adenomas)
sarcoidosis
histiocytosis
hemochromatosis
Sheehan syndrome (postpartum pituitary necrosis)
lymphocytic hypophysitis
family history of central hypothyroidism
anticonvulsant drugs

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

serum free thyroxine (FT4)
serum thyroid-stimulating hormone (TSH)

Detalhes completos

Investigações a serem consideradas

pituitary MRI
head CT
serum prolactin (PRL)
fasting morning serum cortisol
serum testosterone
serum gonadotropins
genetic analyses

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

all patients

Colaboradores

Autores

Angela M. Leung, MD, MSc

Associate Professor of Medicine

UCLA David Geffen School of Medicine

VA Greater Los Angeles Healthcare System

Los Angeles

Declarações

AML serves on the board of directors of the American Thyroid Association (ATA); speaks for China Merck; consulted for Vertice Pharma; and received article process charges paid on behalf of IBSA Institut Biochimique for an invited review article.

Agradecimentos

Dr Angela M. Leung would like to gratefully acknowledge Dr Jacqueline Gilbert and Dr Rasa Zarnegar, previous contributors to this topic.

Declarações

JG and RZ declare that they have no competing interests.

Revisores

James Lee, MD

Assistant Professor

Department of Endocrine Surgery

Columbia University

New York

Declarações

JL declares that he has no competing interests.

James V. Hennessey, MD

Director of Clinical Endocrinology

Beth Israel Deaconess Medical Center

Boston

Declarações

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

Declarações

AW declares that he has no competing interests.

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Declarações

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Persani L, Brabant G, Dattani M, et al. 2018 European Thyroid Association (ETA) guidelines on the diagnosis and management of central hypothyroidism. Eur Thyroid J. 2018 Oct;7(5):225-37.Texto completo Resumo

Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. Resumo

Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014 Dec;24(12):1670-751.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Primary hypothyroidism
- Nonthyroidal illness
- Iodine deficiency
Mais Diagnósticos diferenciais
Diretrizes
- Hypothalamic-pituitary and growth disorders in survivors of childhood cancer
- Guidelines on the diagnosis and management of central hypothyroidism
Mais Diretrizes
Folhetos informativos para os pacientes
Underactive thyroid
Underactive thyroid: questions to ask your doctor
Mais Folhetos informativos para os pacientes
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Central hypothyroidism

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Angela M. Leung, MD, MSc

Declarações

Agradecimentos

Declarações

Revisores

James Lee, MD

Declarações

James V. Hennessey, MD

Declarações

Anthony Weetman, MD, DSc, FRCP, FMedSci

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice