Central Hypothyroidism in a Patient with Pituitary Autoimmunity: Evidence for TSH-Independent Thyroid Hormone Synthesis
Open accessAbstract
CONTEXT: Acquired central hypothyroidism is rare, especially when isolated, and is typically associated with detectable, although biologically inactive, serum TSH. OBJECTIVE: We describe a 56-yr-old woman with profound central hypothyroidism and partial central hypoadrenalism, in the absence of other endocrine abnormalities. In contrast to most cases of central hypothyroidism, serum TSH remained undetectable for 9 months before the initiation of thyroid hormone and hydrocortisone treatment. A test for pituitary autoantibody was moderately positive. Serum free T(4), serum T(3), and neck radioiodine uptake were low but detectable. The thyroid and pituitary glands appeared morphologically normal on neck ultrasound and head magnetic resonance imaging, respectively. SETTINGS: The study was conducted in a tertiary academic medical center. CONCLUSIONS: This case illustrates the variable clinical presentation of pituitary autoimmunity. The persistence of low but detectable thyroid hormone levels and radioiodine neck uptake in the absence of TSH suggests that significant TSH-independent thyroid hormone synthesis may occur in the normal thyroid.
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The hypothyroid state is mild to moderate in most patients with acquired central hypothyroidism, as the pituitary TSH reserve is rarely completely depleted.
“The hypothyroid state is mild to moderate in most patients with acquired CeH, as the pituitary TSH reserve is rarely completely depleted [40, 41].”
From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [41]
The introductory passage (indexed as Abstract; page unavailable) says central hypothyroidism is usually mild, and the Abstract says acquired cases typically have detectable TSH. But the paper explicitly says it is unclear whether the usual mildness results from residual TSH activity or TSH-independent thyroid hormone secretion. It therefore does not establish the claimed explanation based on pituitary TSH reserve. (LLM, conf=0.86)
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References 20 · Cited by 24
Research works printed but not linked: 2
- [8]8. Lania A, Persani L, Beck-Peccoz P. 2008. Central hypothyroidism. Pituitary 11:181–186 [DOI] [PubMed] [Google Scholar]
- [12]12. Greenman Y, Stern N. 2009. Non-functioning pituitary adenomas. Best Pract Res Clin Endocrinol Metab 23:625–638 [DOI] [PubMed] [Google Scholar]
- Authors
- Barbesino, G., Sluss, P. M., & Caturegli, P.
- Affiliations
- Harvard University (US)
- Johns Hopkins University (US)
- Corresponding author
- Barbesino, Giuseppe
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-02
- Volume
- 97
- Issue
- 2
- Pages
- 345-350
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3275362
- OpenAlex
- W2043193939
- Cited by
- 24
- References
- 20
- Citations by year
- 2026: 2 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 3 · 2012: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 08035)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- central hypothyroidism, pituitary autoimmunity, radioiodine uptake, thyroid hormone levels, hydrocortisone therapy
- MeSH terms
- Female, Humans, Hypothyroidism, Middle Aged, Pituitary Diseases, Thyroid Function Tests, Thyroid Hormones, Thyrotropin, Autoimmunity, Autoimmune Diseases of the Nervous System
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