CoChat
Sign Up
Cited by 140Thyroid Disorders and TreatmentsPituitary Gland Disorders and TreatmentsAdrenal Hormones and Disorders

Central hypothyroidism — a neglected thyroid disorder

Beck-Peccoz, Paolo, Rodari, Giulia, Giavoli, Claudia, Lania, Andrea·2017·Nature Reviews Endocrinology
DOI 10.1038/nrendo.2017.47
Open this paper in CoChat — free account

Abstract

Central hypothyroidism is a rare and heterogeneous disorder that is characterized by a defect in thyroid hormone secretion in an otherwise normal thyroid gland due to insufficient stimulation by TSH. The disease results from the abnormal function of the pituitary gland, the hypothalamus, or both. Moreover, central hypothyroidism can be isolated or combined with other pituitary hormone deficiencies, which are mostly acquired and are rarely congenital. The clinical manifestations of central hypothyroidism are usually milder than those observed in primary hypothyroidism. Obtaining a positive diagnosis for central hypothyroidism can be difficult from both a clinical and a biochemical perspective. The diagnosis of central hypothyroidism is based on low circulating levels of free T 4 in the presence of low to normal TSH concentrations. The correct diagnosis of both acquired (also termed sporadic) and congenital (also termed genetic) central hypothyroidism can be hindered by methodological interference in free T 4 or TSH measurements; routine utilization of total T 4 or T 3 measurements; concurrent systemic illness that is characterized by low levels of free T 4 and normal TSH concentrations; the use of the sole TSH-reflex strategy, which is the measurement of the sole level of TSH, without free T 4, if levels of TSH are in the normal range; and the diagnosis of congenital hypothyroidism based on TSH analysis without the concomitant measurement of serum levels of T 4. In this Review, we discuss current knowledge of the causes of central hypothyroidism, emphasizing possible pitfalls in the diagnosis and treatment of this disorder.

Integrity signals

Registry

Crossref · 10.1038/nrendo.2017.47

Cites

137 of 137 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In comparison with primary hypothyroidism, there is a higher frequency of conditions increasing thyroid hormone requirements in CeH because of persistent impact from rhGH.

    “In comparison with primary hypothyroidism, there is a higher frequency for such conditions because of the persistent impact from rhGH (reviewed in [63]).”

    From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [63]

  • Acquired forms of CeH are usually sporadic and in most cases due to large pituitary macroadenomas with suprasellar extensions, craniopharyngiomas and suprasellar tumors, head trauma, vascular accident or cranial irradiation.

    “Acquired forms of CeH are usually sporadic and in most cases due to large pituitary macroadenomas with a suprasellar extensions, craniopharyngiomas and suprasellar tumors, head trauma, vascular accident or cranial irradiation (1, 28, 33).”

    From The diagnosis and management of central hypothyroidism in 2018 (2019) · cites this paper as [33]

  • Introduction of sex steroid or GH replacement therapies often requires uptitration of L-T4.

    “the introduction of these replacement therapies often requires an uptitration of L-T4”

    From The diagnosis and management of central hypothyroidism in 2018 (2019) · cites this paper as [33]

  • Estrogens and GH influence thyroid hormone transport and/or metabolism and consequently interfere with central hypothyroidism management.

    “Both estrogens and GH influence thyroid hormone transport and/or metabolism and consequently interfere CeH management (33, 60).”

    From The diagnosis and management of central hypothyroidism in 2018 (2019) · cites this paper as [33]

  • Sex steroid and GH deficiencies can mask an underlying central hypothyroidism.

    “Sex steroid and GH deficiencies can mask an underlying CeH”

    From The diagnosis and management of central hypothyroidism in 2018 (2019) · cites this paper as [33]

Cites

Flagged first, then by citations

3 of the 140 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Beck-Peccoz, P., Rodari, G., Giavoli, C., & Lania, A.
Affiliations
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
  • Humanitas University (IT)
ORCID
Venue
Nature Reviews Endocrinology
Publisher
Springer Science and Business Media LLC
Published
2017-05-26
Volume
13
Issue
10
Pages
588-598
ISSN
  • 1759-5029 (ISSN-L)
  • 1759-5037
DOI
10.1038/nrendo.2017.47
OpenAlex
W2616986899
Cited by
140
References
140
Citations by year
2026: 12 · 2025: 22 · 2024: 15 · 2023: 8 · 2022: 19 · 2021: 17 · 2020: 13 · 2019: 16 · 2018: 14 · 2017: 3 · 2016: 1
FWCI
1.83
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Nature Reviews Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
central hypothyroidism, TSH deficiency, pituitary dysfunction, hypothalamic dysfunction, free thyroxine, pituitary hormone deficiency, thyroid hormone secretion, treatment
MeSH terms
Female, Humans, Hypothalamus, Hypothyroidism, Male, Pituitary Gland, Thyroid Function Tests, Thyroid Gland, Thyroid Hormones, Thyroxine, Treatment Outcome, Risk Assessment, Rare Diseases, Neglected Diseases

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review