Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presença de fatores de risco
- fraqueza
- fadiga
- intolerância ao frio
Otros factores de diagnóstico
- redução da memória
- constipação
- cãibras musculares
- ganho de peso
- depressão
- pele seca e áspera
- oligomenorreia/amenorreia
- bradicardia
- redução dos pelos e cabelos
- retardo do relaxamento dos reflexos tendinosos profundos
- deficiência auditiva
- expressão facial impassível
- diabetes insípido (DI)
- cefaleia
- diplopia
- redução da visão periférica
- mamas atróficas
- galactorreia
- fácies de lua cheia
- corcunda de búfalo
Factores de riesgo
- presença de lesões hipofisárias com efeito de massa
- neoplasia endócrina múltipla (NEM) tipo I
- irradiação da cabeça e do pescoço
- lesão cerebral traumática (LCT)
- idade entre 5 a 15 anos e 45 a 60 anos (craniofaringiomas)
- idade 20 a 50 anos (prolactinomas)
- idade 40 a 80 anos (adenomas hipofisários não funcionais)
- sarcoidose
- histiocitose
- hemocromatose
- Síndrome de Sheehan (necrose hipofisária pós-parto)
- hipofisite linfocítica
- história familiar de hipotireoidismo central
- medicamentos anticonvulsivantes
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- tiroxina livre (T4L) sérica
- hormônio estimulante da tireoide (TSH) sérico
Investigations to consider
- ressonância nuclear magnética (RNM) da hipófise
- tomografia computadorizada (TC) de crânio
- prolactina sérica (PRL)
- cortisol sérico de manhã em jejum
- testosterona sérica
- gonadotrofinas séricas
- análises genéticas
Treatment algorithm
todos os pacientes
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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
- Hipotireoidismo primário
- Doença não tireoidiana (DNT)
- Deficiência de iodo
More DifferentialsGuidelines
- Thyroid disease: assessment and management
- Guidelines on the diagnosis and management of central hypothyroidism
More GuidelinesPatient information
Hipotireoidismo
Hipotireoidismo: perguntas a fazer ao seu médico
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