Summary
Definition
History and exam
Key diagnostic factors
- weakness
- fatigue
- cold intolerance
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic tests
1st tests to order
- serum free thyroxine (FT4)
- serum thyroid-stimulating hormone (TSH)
Tests to consider
- pituitary MRI
- head CT
- serum prolactin (PRL)
- fasting morning serum cortisol
- serum testosterone
- serum gonadotropins
- genetic analyses
Treatment algorithm
all patients
Contributors
Authors
Angela M. Leung, MD, MSc
Associate Professor of Medicine
UCLA David Geffen School of Medicine
VA Greater Los Angeles Healthcare System
Los Angeles
CA
Disclosures
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.
Acknowledgements
Dr Angela M. Leung would like to gratefully acknowledge Dr Jacqueline Gilbert and Dr Rasa Zarnegar, previous contributors to this topic.
Disclosures
JG and RZ declare that they have 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.
References
Key articles
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.Full text Abstract
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. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Primary hypothyroidism
- Nonthyroidal illness
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