Features of diagnosis and treatment of central hypothyroidism

Abstract

Review of literature is devoted to central (se­condary) hypothyroidism, a rare disease. There is a number of questions and difficulties in diagnosis and management of this condition. The main causes of central hypothyroidism in adults are tumors of the hypothalamic-pituitary region and the state after surgical and radiation effects on this area. Hormonally active and inactive pituitary macroadenomas cause acquired central hypothyroidism in more than 50 % of cases. The development of secondary hypothyroidism is possible years after the radiotherapy for brain tumors. As with primary hypothyroidism, the clinical manifestations of secondary hypothyroidism are non-specific. Diagnosis and management of this pathology is often complicated by its combination with the deficiency of other tropic hormones. The diagnosis of secondary hypothyroidism is based on anamnestic data and laboratory tests — the simultaneous determination of the levels of free thyroxine and thyroid-stimulating hormone. The level of free thyroxine is also used as the main marker for the adequacy of levothyroxine dose in the treatment of central hypothyroidism. The results of recent studies help us to optimize replacement therapy in secondary hypothyroidism. However, the use of additional biochemical markers to assess the adequacy of replacement therapy remains unexplored.

Keywords

• central hypothyroidism
• diagnosis
• levothyroxine
• replacement therapy
• review