Central hypothyroidism

Last reviewed: 4 Jun 2022
Last updated: 29 May 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • weakness
  • fatigue
  • cold intolerance
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • serum free thyroxine (T4)
  • serum thyroid-stimulating hormone (TSH)
More 1st investigations to order

Investigations to consider

  • MRI of brain
  • CT head
  • prolactin (PRL)
  • 9 a.m. serum cortisol
  • serum testosterone
  • serum gonadotrophins
  • genetic analyses
More investigations to consider

Treatment algorithm


all patients



Jacqueline Gilbert, PhD, MRCP

Consultant Endocrinologist

King's College Hospital NHS Foundation Trust




JG declares that she has no competing interests.


Dr Jacqueline Gilbert would like to gratefully acknowledge Dr Rasa Zarnegar, a previous contributor to this topic.


RZ declares that he has no competing interests.

Peer reviewers

James Lee, MD

Assistant Professor

Department of Endocrine Surgery

Columbia University

New York



JL declares that he has no competing interests.

James V. Hennessey, MD

Director of Clinical Endocrinology

Beth Israel Deaconess Medical Center




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




AW declares that he has no competing interests.

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