Male Hypothyroidism-Clinical Relevance Including Role in Reproduction

Abstract

Purpose: Overt Hypothyroidism is defined as arise of S.TSH>10mIU/L. Since its incidence is more common in females one generally tends to ignore this diagnosis in males and usually the diagnosis is made in an emergency situation when the patient presents either with coma or with a severe form of Hashimoto's thyroiditis (HT) like IgG4 related thyroiditis. Methods: A systemic literature search was performed using PubMed for all English articles till Sept 2014 regarding male hypothyroidism using MeSH terms like congenital hypothyroidism, male hypothyroidism and reproduction; subclinical hypothyroidism; Hoffmann's syndrome; myxedemic coma. Results: To eradicate congenital hypothyroidism all over the world many countries have incorporated in their neonatal screening programme (NNSP), yet occasional cases of cretinism still get diagnosed .Important causes being genes encoding Transcription factor TTX1, TTX2 presenting as Bamforth syndrome, Thyroglobulin gene, Thyroid peroxidase (TPO), TSHR gene abnormalities, Pendreds syndrome coexisting with thyroid developmental abnormalities etc. Context Ig superfamily1deficiency (IGSF1), Fryns Anophthalmia Plus syndrome (APS), TSHβ gene deletion, frame shift mutation in first exon of Fibroblast growth factor8 (FGF8) can present as Central hypothyroidism. The first presentation maybe a neurological emergency like myxedemic coma either secondary to neurofibromatosis, lithium toxicity which responds to L-thyroxin or occasionally may not, responding only to steroids. Some patients may present as different forms of Hoffmann's syndrome or stiff leg syndromes. Subclinical hypothyroidis, (SH) and its aetiology along with TSH R mutations R109 Qreported as causation in 2 brothers and importance of treatment is highlighted. Importance of treatment of SH in children and adults is discussed. Mechanism of reversible kidney dysfunction in hypothyroidism is highlighted along with discussing its relationship with treatment. Changes in serum testosterone and gonadotropins are discussed in a patient of male hypothyroidism and the way it may affect reproduction. Conclusion: Hypothyroidism may be the primary cause of a male presenting with Hypogonadotropic hypogonadism (HH) and should be suspected in a man presenting with delayed puberty. Untreated hypothyroidism should be suspected as the cause of presentation of myopathies like Hoffmann Syndrome or other myopathies or myxedema coma. SH may warrant treatment in young males with known adverse affects on cardiovascular system although its affect on cognitive function has not been found especially in elderly.