Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients
Abstract
Hypothyroidism is characterized by hypometabolism, and may be seen as a part of secondary failure due to pituitary insufficiency or tertiary due to hypothalamic disease. Secondary and tertiary failures are also referred to as central hypothyroidism. Whereas overt primary hypothyroidism has a well-known affection on the heart and cardiovascular system, and may result in cardiac failure, cardiovascular affection is less well recognized in central hypothyroidism. Studies on central hypothyroidism and cardiovascular outcome are few and given the rarity of the diseases often small. Further, there are several limitations given vast difficulties in diagnosing the condition correctly biochemically, and difficulties monitoring the treatment because normal thyroid-pituitary feedback interrelationships are disrupted. The present review summarizes available studies of central adult hypothyroidism and its possible influence on the cardiovascular system, describe differences from primary thyroid failure and seek evidence for performing guidelines for clinical management of this particular thyroid and hypothalamo-pituitary disorder.
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Mean L-T4 daily doses of 1.2-1.6 μg/kg bw/day were judged sufficient in the large majority of adult CeH patients.
“Indeed, mean L-T4 daily doses of 1.2-1.6 μg/kg bw/day were judged sufficient in the large majority of adult CeH patients, with the main aim of achieving a more appropriate metabolic profile [24, 25, 55].”
From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [55]
Women with multiple pituitary hormone deficiencies on estrogen replacement or oral contraceptives are at high risk of suboptimal replacement with a consequent worse metabolic profile.
“In case of multiple pituitary hormone deficiencies, the situation becomes more complex, e.g., in women on estrogen replacement therapy (or on oral contraceptive drugs), except worse, since TSH cannot be used [52]. These women are, therefore, at high risk of suboptimal replacement with a consequent worse metabolic profile [53].”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [53]
Undertreated central hypothyroidism is associated with increased risk for cardiovascular morbidity.
“with increased risk for cardiovascular morbidity (108).”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [108]
Immunoreactive serum TSH is often measurable in patients with central thyroid deficiency, a phenomenon resulting from dissociation between biological and immunological TSH activity.
“Yet, immunoreactive serum TSH is often measurable in patients with central thyroid deficiency, a phenomenon resulting from dissociation between biological and immunological TSH activity (Fig. 7) (Oliveira et al., 2001;Feldt-Rasmussen and Klose, 2016;Persani 2000).”
From The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions (2021) · cites this paper as Feldt-Rasmussen and Klose, 2016
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References 96 · Cited by 43
- Authors
- Feldt-Rasmussen, U., & Klose, M.
- Affiliations
- University of Copenhagen (DK)
- Venue
- Endocrine
- Published
- 2016-08-01
- Volume
- 54
- Issue
- 1
- Pages
- 15-23
- ISSN
- 0969-711X (ISSN-L)
- 1355-008X
- 1559-0100
- OpenAlex
- W2481523368
- Cited by
- 43
- References
- 96
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 5 · 2015: 1
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Novo Nordisk Fonden (NNF15OC0014622)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- central hypothyroidism, hypopituitarism, cardiovascular risk factors, primary hypothyroidism, cardiovascular outcomes, thyroid hormone replacement, clinical management guidelines
- MeSH terms
- Cardiovascular Diseases, Humans, Hypopituitarism, Hypothyroidism, Risk Factors, Thyroxine
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