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The diagnosis and management of central hypothyroidism in 2018
Central hypothyrodism (CeH) is a hypothyroid state caused by an insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland. Several advancements, including the recent publication of expert guidelines for CeH diagnosis and management, have been made in recent years thus increa...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Bioscientifica Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373625/ https://www.ncbi.nlm.nih.gov/pubmed/30645189 http://dx.doi.org/10.1530/EC-18-0515 |
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author | Persani, Luca Cangiano, Biagio Bonomi, Marco |
author_facet | Persani, Luca Cangiano, Biagio Bonomi, Marco |
author_sort | Persani, Luca |
collection | PubMed |
description | Central hypothyrodism (CeH) is a hypothyroid state caused by an insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland. Several advancements, including the recent publication of expert guidelines for CeH diagnosis and management, have been made in recent years thus increasing the clinical awareness on this condition. Here, we reviewed the recent advancements and give expert opinions on critical issues. Indeed, CeH can be the consequence of various disorders affecting either the pituitary gland or the hypothalamus. Recent data enlarged the list of candidate genes for heritable CeH and a genetic origin may be the underlying cause for CeH discovered in pediatric or even adult patients without apparent pituitary lesions. This raises the doubt that the frequency of CeH may be underestimated. CeH is most frequently diagnosed as a consequence of the biochemical assessments in patients with hypothalamic/pituitary lesions. In contrast with primary hypothyroidism, low FT4 with low/normal TSH levels are the biochemical hallmark of CeH, and adequate thyroid hormone replacement leads to the suppression of residual TSH secretion. Thus, CeH often represents a clinical challenge because physicians cannot rely on the use of the ‘reflex TSH strategy’ for screening or therapy monitoring. Nevertheless, in contrast with general assumption, the finding of normal TSH levels may indicate thyroxine under-replacement in CeH patients. The clinical management of CeH is further complicated by the combination with multiple pituitary deficiencies, as the introduction of sex steroids or GH replacements may uncover latent forms of CeH or increase the thyroxine requirements. |
format | Online Article Text |
id | pubmed-6373625 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-63736252019-02-20 The diagnosis and management of central hypothyroidism in 2018 Persani, Luca Cangiano, Biagio Bonomi, Marco Endocr Connect Review Central hypothyrodism (CeH) is a hypothyroid state caused by an insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland. Several advancements, including the recent publication of expert guidelines for CeH diagnosis and management, have been made in recent years thus increasing the clinical awareness on this condition. Here, we reviewed the recent advancements and give expert opinions on critical issues. Indeed, CeH can be the consequence of various disorders affecting either the pituitary gland or the hypothalamus. Recent data enlarged the list of candidate genes for heritable CeH and a genetic origin may be the underlying cause for CeH discovered in pediatric or even adult patients without apparent pituitary lesions. This raises the doubt that the frequency of CeH may be underestimated. CeH is most frequently diagnosed as a consequence of the biochemical assessments in patients with hypothalamic/pituitary lesions. In contrast with primary hypothyroidism, low FT4 with low/normal TSH levels are the biochemical hallmark of CeH, and adequate thyroid hormone replacement leads to the suppression of residual TSH secretion. Thus, CeH often represents a clinical challenge because physicians cannot rely on the use of the ‘reflex TSH strategy’ for screening or therapy monitoring. Nevertheless, in contrast with general assumption, the finding of normal TSH levels may indicate thyroxine under-replacement in CeH patients. The clinical management of CeH is further complicated by the combination with multiple pituitary deficiencies, as the introduction of sex steroids or GH replacements may uncover latent forms of CeH or increase the thyroxine requirements. Bioscientifica Ltd 2019-01-15 /pmc/articles/PMC6373625/ /pubmed/30645189 http://dx.doi.org/10.1530/EC-18-0515 Text en © 2019 The authors http://creativecommons.org/licenses/by-nc/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | Review Persani, Luca Cangiano, Biagio Bonomi, Marco The diagnosis and management of central hypothyroidism in 2018 |
title | The diagnosis and management of central hypothyroidism in 2018 |
title_full | The diagnosis and management of central hypothyroidism in 2018 |
title_fullStr | The diagnosis and management of central hypothyroidism in 2018 |
title_full_unstemmed | The diagnosis and management of central hypothyroidism in 2018 |
title_short | The diagnosis and management of central hypothyroidism in 2018 |
title_sort | diagnosis and management of central hypothyroidism in 2018 |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373625/ https://www.ncbi.nlm.nih.gov/pubmed/30645189 http://dx.doi.org/10.1530/EC-18-0515 |
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