Symptoms of central hypothyroidism include those of primary hypothyroidism (fatigability, cold intolerance, weight gain), with or without other symptoms of hypopituitarism, including hypogonadism and secondary adrenal insufficiency.
Signs on physical examination may indicate hypothyroidism, including skin changes, hair loss, and bradycardia.
Signs indicating a sellar or parasellar mass include papilloedema and visual field deficits (a bitemporal hemianopia).
Diagnostic evaluation of central hypothyroidism includes serum TSH and free T4. In central hypothyroidism, free T4 is low and TSH may be low, normal, or minimally elevated. MRI may reveal sellar or parasellar pathology.
Treatment of central hypothyroidism is by thyroid hormone replacement (levothyroxine).
Complications of treatment may include thyrotoxicosis and osteoporosis.
Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones, which results in a generalised slowing of metabolic processes. Central hypothyroidism is the result of anterior pituitary or hypothalamic hypofunction. It may be the result of congenital, neoplastic, inflammatory, infiltrative, traumatic, or iatrogenic aetiologies. It is characterised by decreased TSH secretion in turn causing decreased thyroid hormone synthesis and release.
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 monograph. RZ declares that he has no competing interests.
Department of Endocrine Surgery
JL declares that he has no competing interests.
Director of Clinical Endocrinology
Beth Israel Deaconess Medical Center
JVH declares that he has no competing interests.
Sir Arthur Hall Professor of Medicine/Pro Vice Chancellor
University of Sheffield
AW declares that he has no competing interests.
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