The Etiology of Isolated Thyroid Stimulating Hormone Deficiency

Hashimoto, Kozo

doi:10.2169/internalmedicine.37.231

Cited by 9 publications

(2 citation statements)

References 19 publications

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“…Multiple pituitary deficiencies are associated with such processes, with symptoms of hypothyroidism, as well as symptoms of gonadotropin, growth hormone and usually adrenocorticotrophic hormone deficiencies. Acquired isolated TSH deficiency is rarely seen 29 31 32. TSH deficiency also usually manifests after the development of growth hormone and gonadotropin deficencies,33 which were not evident in this patient.…”

Section: Discussionmentioning

confidence: 64%

Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis

Cating-Cabral

Cabungcal²,

Villafuerte³

et al. 2012

BMJ Case Reports

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This is a case of a 44-year-old woman with an anterior neck mass and hypothyroidism who presented with an incidental finding of an elevated serum calcium level and was found to have primary hyperparathyroidism and osteoporosis. During surgical exploration no parathyroid adenoma was found, although a nodule was palpated within the right thyroid lobe. Examination of the excised right thyroid lobe revealed an intrathyroidal parathyroid adenoma and chronic lymphocytic thyroiditis. After surgery, she did not develop severe hypocalcaemia and this was attributed to preoperative treatment with pamidronate. In the months following surgery, parathyroid hormone remained undetectable.

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Section: Discussionmentioning

confidence: 64%

Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis

Cating-Cabral

Cabungcal²,

Villafuerte³

et al. 2012

BMJ Case Reports

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“…The disease occurs in either rare genetic forms, where abnormalities of various genes (TSHb, TRH receptor, Pit-1, Prop-1) have been identified (1 -4), or more commonly in a sporadic, acquired form. It is almost always associated with deficient secretions of other pituitary hormones and idiopathic isolated CH remains extremely rare (5).…”

Section: Introductionmentioning

confidence: 99%

Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients

et al. 2004

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Objective: We studied the clinical and hormonal profiles of patients with central hypothyroidism (CH), the adequacy of levothyroxine (L-T4) treatment and the influence of other pituitary hormone replacement therapies. Methods: We reviewed medical records of 108 adult patients with child-onset (CO; n ¼ 26) or adultonset (AO; n ¼ 82) CH. Results: At diagnosis, the most frequently reported symptoms were fatigue and headaches in AO patients, and growth retardation in CO patients. Serum TSH was normal in a majority of CH patients, low in 8% and elevated in 8%. Serum free thyroxine (fT 4 ) was usually reduced, but remained within the low normal range in 28% of the study population (mostly CO patients). Similarly, serum total T 4 (tT 4 ), total triiodothyronine (tT 3 ) and free T 3 (fT 3 ) were found to be within the normal range in significant subsets of patients. Interestingly, the clinical and biochemical characteristics of CH patients with normal f/t T 4 levels were not different from those of the patients with low fT 4 values. The thyroid hormonal profile was not influenced by gender, etiology or by the number of hormone deficiencies. At last evaluation, the mean dose of L-T 4 was 1.6^0.5 mg/kg/day and was negatively correlated to current age (P , 0.001) but positively correlated to the number of hormone deficiencies (P , 0.05). Treatment suppressed TSH in 75% of the patients, induced normal fT 4 in 94%, but normal fT 3 in only 49% of them. Male GH-treated patients and estrogen-treated females needed a higher L-T 4 dose compared with non-treated patients. Conclusions: fT 4 is clearly the best indicator of CH, but remains in the low normal range in a significant subset of patients, especially in those with CO disease. Adequacy of therapy is mostly reflected by the combination of upper normal fT 4 and low normal fT 3 levels. Pituitary hormone replacement therapy may require an adjustment of T 4 treatment, as female patients under estrogen treatment and male patients under GH treatment will need a higher T 4 dose in order to remain in the euthyroid range.European Journal of Endocrinology 150 1-8

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Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients

Feldt‐Rasmussen

Klose

2016

Endocrine

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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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The Etiology of Isolated Thyroid Stimulating Hormone Deficiency

Cited by 9 publications

References 19 publications

Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis

Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis

Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients

Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients

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